I’m struggling more and more Covers rising costs Popular GLP-1 drugs like Wegovy, Ozempic and Zepbound are looking for ways to get out of under the shocked budget narrowing.
One solution that some policymakers can try is to limit the number of Medicaid people who can use expensive diabetes medications for weight loss purposes.
Pennsylvania’s drug Medicaid coverage is expected to cost $1.3 billion in 2025, a fraction of what it was a few years ago, helping to forecast a multi-billion-dollar budget deficit. The state is considering requiring Medicaid patients who want to use GLP-1 to meet a certain number of weight loss Body Mass Index Or try a diet and exercise program or cheap medication first.
Pennsylvania Human Services Secretary Dr. Val Alcoche told a state Capitol hearing in March.
At least 14 states have already covered the costs of GLP-1 drugs for obesity treatment in patients with Medicaid, a federal healthcare program for low-income people. Democrats and Republicans from at least a half dozen other states have brought the bill to the surface this year to demand the same compensation. Invoice Tracking Software Plural.
While some bills are stagnant, others live on, but include proposals in Arkansas, which include requiring GLP-1 to be Medicaid if prescribed specifically for weight loss. Iowa lawmakers are considering ordering a cost-benefit analysis before making their commitments. already, West Virginia and North Carolina In 2024, we ended a program that provided compensation to state employees, citing cost concerns.
“It’s very expensive,” said Jeffrey Beckham, Connecticut’s state budget director. Here, Medicaid drug compensation for weight loss may be completely discarded. “Other states have come to that conclusion and some civil airlines have come to it.”
Overall Medicaid spending on GLP-1 drugs before partial rebates from drug manufacturers jumped from $577.3 million in 2019 to $3.9 billion in 2023. November report From KFF, a nonprofit organization that studies healthcare issues. The number of drug prescriptions increased by more than 400% during that same period. The average annual cost per patient for GLP-1 drugs is $12,000. Peterson-KFF Tracker.
About half of Americans prefer to take “strong” or “somewhat” Medicare and Medicaid and prefer to cover weight loss pills for obese people. Recent AP-NORC public theory About two in ten people opposed the idea, with about a quarter shown in neutral views.
However, Medicare does not cover GLP-1 The Trump administration said Friday It will not introduce proposed rules by the president’s predecessor, Joe Biden, to cover drugs based on Medicare’s Part D prescription drug coverage. Biden’s proposal was expensive. It includes all state and federally funded Medicaid program coverage, which cost taxpayers $35 billion over the next decade.
The states offering coverage have sought to manage costs by setting prescription limits on GLP-1. There is also some evidence that Medicaid patients lose drugs and weight, making them healthier and cheaper to cover, said Tracy Zvegnac, an advocacy group that encourages them to provide compensation.
Zvenyach also emphasized that it is unclear whether patients should take these drugs regularly for the rest of their lives. This is a major cost concern raised by civil servants. “Someone might have to get treatment for the rest of her life,” she said. “But I don’t know exactly what that regimen looks like.”
Approximately 40% of US adults are obeseaccording to the US Centers for Disease Control and Prevention. Obesity can cause high blood pressure, type 2 diabetes, and high cholesterol, which increases the risk of strokes and heart attacks.
Dr. Adam Rafaellom, a doctor at Greater Philadelphia Health Action, a network of health centers in the city, said that most patients taking GLP-1 are eligible for Medicaid, with some being non-diabetic patients who use it for weight loss.
“I asked one patient to say it turned her relationship into food,” Rom said. “We lost to patients like 20, 40, 60 pounds.”
but Obesity experts say one in five people on the Associated Press You may not be able to lose weight that other people see. And with a Recent surveys The state’s Medicaid directors implemented by the health policy research institute KFF, have said they are cost-based. Potential side effects It’s one of their concerns.
The coverage debate coincides with rising Medicaid budgets and the prospect of losing federal funds. Congressional Republicans considering siphoning $880 billion out of Medicaid The next 10 years.
Connecticut is facing a $290 million Medicaid account deficit, and Democratic government Ned Lamont proposed that Medicaid has repealed the 2023 requirement that GLP-1 cover GLP-1 due to severe obesity, but the state is not fully complying with the law.
However, starting June 14th, state Medicaid patients will need to receive a diagnosis of type 2 diabetes and cover their medication. Lamont is also asking the state to cover two inexpensive oral medications that the FDA has approved for weight loss and nutritional counseling.
Sarah Makobiki, 42, said she has tried other medications and suffered from serious side effects. Graduate students and State House interns are working on a bill that will restore full GLP-1 coverage for her and others.
Sarah Lamontagne, a disability transgender woman taking Medicaid, said she regained weight when coverage of GLP-1 drugs was previously blocked. She said she was heavier than ever, going from 260 pounds to over 300.
“So it’s a scary game to play and a scary game to interact with,” said Lamontagne, who is trying to appeal to the state’s recent denial of her Ozempic prescription supplement.
Makowicki said she combined GLP-1 medication with weight loss surgery to help her change her life.
“I’m a different person than I was five years ago,” Makobiki said. “Not only in my physical space, but also in my mental state.”
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Hay was reported from Hartford, Connecticut. Levy was reported from Harrisburg, Pennsylvania.
