States that fight more and more cover up Of the popular drugs of LPG-1 such as Wegovy, Ozempic and Zepbound are looking for ways to get out of the budget presentation that surprised them.
A solution that some political leaders can try is to restrict the number of people in Medicaid who can use the expensive diabetes medications for weight loss purposes.
It is expected that Medicaid coverage of Penylvania medicines cost $ 1.3 billion in 2025, compared to a fraction of that several years ago, and is contributing to the projections of a multimillion -dollar budget deficit. The State is thinking of demanding Medicaid patients to use LPG-1 to lose weight to meet a certain number in the Body mass index Or try diet and exercise programs or medications less expensive first.
“It is a medication that has received a lot of advertising and a lot of press, and has become very popular in its use and is very expensive,” said Dr. Val Arkoosh, secretary of Human Services of Pennsylvania, in a audience of the State House in March.
At least 14 states already cover the cost of GLP-1 medicines for the treatment of obesity for patients in Medicaid, the Federal Medical Care Program for people with low income. Democrats and Republicans in at least half a dozen other states floated bills this year to require the same coverage, according to an analysis of Associated Press using the plural tickets tracking software.
Some bills have stagnated while others remain alive, including a proposal in Arkansas that requires GLP-1 to be covered by Medicaid when specifically prescribed to lose weight. Iowa legislators are thinking of ordering a cost-benefit analysis before committing. Already, W.V. and North Carolina Final programs in 2024 that provided coverage for state employees, citing cost concerns.
“It’s very expensive,” said Jeffrey Beckham, director of state budget at Connecticut, where Medicaid coverage of weight loss drugs can be completely discarded. “Other states are reaching that conclusion, as well as some private operators.”
The general expenditure of Medicaid in GLP-1 medicines, before partial reimbursements of drug manufacturers, increased from $ 577.3 million in 2019 to $ 3.9 billion in 2023, according to To a November report of KFF, a non -profit organization that investigates medical care problems. The number of recipes for medications increased by more than 400% during that same period of time. The average annual cost per patient for a GLP-1 drug is $ 12,000, according to a Peterson-Kff tracker.
Around half of the Americans “strongly” or “something” favor having Medicare and Medicaid cover the medicines for weight loss for people who have obesity, a Recent AP-NORC Survey He demonstrated, with approximately 2 out of 10 opposite to the idea and approximately a room with a neutral view.
But Medicare does not cover the LPG-1 and the Trump’s administration said Friday That would not imply a proposed rule by the presidential predecessor Joe Biden to cover the medications under the coverage of prescription medications of the Medicare part. Biden’s proposal was expensive: it would have included coverage for all Medicaid programs financed by the State and the Federal, which cost taxpayers up to $ 35 billion in the next decade.
The states that provide coverage have tried to manage costs by placing prescription limits in the LPG-1. There is also some evidence that if patients with Medicaid lose weight with medicines, they will be healthier and less expensive to cover, said Tracy Zvenyach of Obesity Action, a defense group that urges states to provide coverage.
Zvenyach also emphasized how it is not clear if patients should regularly take these medications for the rest of their lives, a key cost concern raised by public officials. “Someone may have to be in treatment during the course of his life,” he said. “But we don’t know exactly what that regime would be like.”
About 40% of adults in the United States have obesityAccording to the US disease control and prevention centers, obesity can cause hypertension, type 2 diabetes and high cholesterol, which leads to greater risks of things such as stroke and heart attacks.
Dr. Adam Raphael Rom, a doctor of Greater Philadelphia Health Action, a network of health centers in the city, said that most of their patients who take LPG-1 are covered by Medicaid and some are not diabetic that use it to lose weight.
“A patient told me it’s like, he changed his relationship with food,” Rom said. “I have had patients who lose like 20, 40, 60 pounds.”
But Obesity experts have told Associated Press that up to 1 in 5 people You may not lose the amount of weight that others have seen. And in a recent survey of the state directors of Medicaid carried out by KFF, a health policy research organization said that the cost and Potential side effects They are among their concerns.
The debate on coverage coincides with the increase in Medicaid budgets and the possibility of losing federal funds, with Congress Republicans who consider divert up to $ 880 billion of Medicaid During the next decade.
Connecticut faces a Medicaid account deficit of $ 290 million, and Democratic governor Ned Lamont proposed to eliminate a 2023 requirement that Medicaid covers LPG-1 for severe obesity, although the State has never completely lasted the law due to the cost.
However, as of June 14, state patients in Medicaid should have a diagnosis of type 2 diabetes to cover medications. Lamont is also pressing for the State to cover two less expensive oral medications approved by FDA for weight loss, as well as nutritional advice.
Sarah Makowicki, 42, tested the other medications and said he suffered serious side effects. The postgraduate student and Statehouse intern is working on a bill that will restore the complete GLP-1 coverage for her and for others.
Sara Lamontagne, a transgender woman with a disability who is in Medicaid, said she regained weight when her coverage for GLP-1 medication was cut in the past. She said that it went from 260 pounds to more than 300, heavier than ever.
“Then, it is a horrible game that is played, returning and coming,” said Lamontagne, whose attempts to appeal the recent denial of his Ozempic prescription recharge have not been successful.
Makowicki said that LPG-1 drugs combined with weight loss surgery helped her change her life: she underwent knee replacement surgery and lost more than 200 pounds.
“I am a different person from what it was five years ago,” Makowicki said. “Not only in my physical space, but also mentally.”
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Haigh reported from Hartford, Connecticut. Levy reported from Harrisburg, Pennsylvania.
