The skyrocketing cost of weight-loss drugs has state Medicaid programs
looking for a solution
[April 07, 2025]
By SUSAN HAIGH and MARC LEVY
States increasingly struggling to cover the rising cost of popular GLP-1
drugs like Wegovy, Ozempic and Zepbound are searching for ways to get
out from under the budgetary squeeze that took them by surprise.
One solution some policymakers may try is restricting the number of
people on Medicaid who can use the pricey diabetes drugs for weight-loss
purposes.
Pennsylvania's Medicaid coverage of the drugs is expected to cost $1.3
billion in 2025 — up from a fraction of that several years ago — and is
contributing to projections of a multibillion-dollar budget deficit. The
state is thinking about requiring Medicaid patients who want to use
GLP-1s for weight loss to meet a certain number on the body-mass index
or try diet and exercise programs or less expensive medications first.
“It is a medication that’s gotten a lot of hype and a lot of press, and
has become very popular in its use and it is wildly expensive,” Dr. Val
Arkoosh, Pennsylvania’s human services secretary, told a state House
hearing in March.
At least 14 states already cover the cost of GLP-1 medications for
obesity treatment for patients on Medicaid, the federal health care
program for people with low incomes. Democrats and Republicans in at
least a half-dozen other states floated bills this year to require the
same coverage, according to an Associated Press analysis using the
bill-tracking software Plural.
Some bills have stalled while others remain alive, including a proposal
in Arkansas requiring GLP-1s to be covered under Medicaid when
prescribed specifically for weight loss. Iowa lawmakers are thinking
about ordering a cost-benefit analysis before making the commitment.
Already, West Virginia and North Carolina ended programs in 2024 that
provided coverage for state employees, citing cost concerns.
“It is very expensive,” said Jeffrey Beckham, the state budget director
in Connecticut, where Medicaid coverage of the drugs for weight loss may
be scrapped entirely. “Other states are coming to that conclusion, as
well as some private carriers.”
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, according to a November report from KFF, a nonprofit that
researches health care issues. The number of prescriptions for the drugs
increased by more than 400% during that same time period. The average
annual cost per patient for a GLP-1 drug is $12,000, according to a
Peterson-KFF tracker.
About half of Americans “strongly” or “somewhat” favor having Medicare
and Medicaid cover weight-loss drugs for people who have obesity, a
recent AP-NORC poll showed, with about 2 in 10 opposed the idea and
about one-quarter with a neutral view.
But Medicare does not cover GLP-1s, and the Trump administration said
Friday that wouldn't put into place a proposed rule by presidential
predecessor Joe Biden to cover the medications under Medicare’s Part D
prescription drug coverage. Biden’s proposal was expensive: It would
have included coverage for all state- and federally funded Medicaid
programs, costing taxpayers as much as $35 billion over next decade.
States that do provide coverage have tried to manage costs by putting
prescribing limits on the GLP-1s. There's also some evidence that if
Medicaid patients lose weight with the drugs, they'll be healthier and
less expensive to cover, said Tracy Zvenyach of Obesity Action, an
advocacy group that urges states to provide coverage.
Zvenyach also stressed how it's unclear whether patients will need to
regularly take these drugs for the rest of their lives — a key cost
concern raised by public officials. “Someone may have to be on treatment
for over the course of their lifetime," she said. "But we don’t know
exactly what that regimen would look like.”
[to top of second column]
|
Sarah Makowicki sits in the Connecticut State Capitol in Hartford,
Conn., on Thursday, March 27, 2025. (AP Photo/Susan Haigh)
 About 40% of adults in the U.S. have
obesity, according to the U.S. Centers for Disease Control and
Prevention. Obesity can cause hypertension, Type 2 diabetes and high
cholesterol, which lead to greater risks of things like stroke and
heart attacks.
Dr. Adam Raphael Rom, a physician at Greater Philadelphia Health
Action, a network of health centers in the city, said most of his
patients who take GLP-1s are covered by Medicaid and some are
non-diabetics who use it for weight loss.
“I had one patient tell me that it’s like, changed her relationship
to food," Rom said. “I’ve had patients lose like 20, 40, 60 pounds."
But obesity experts have told The Associated Press that as many as 1
in 5 people may not lose the amount of weight that others have seen
come off. And in a recent survey of state Medicaid directors
conducted by KFF, a health policy research organization, they said
cost and potential side effects are among their concerns.
The debate over coverage coincides with rising Medicaid budgets and
the prospect of losing federal funding — with congressional
Republicans considering siphoning as much as $880 billion from
Medicaid over the next decade.
Connecticut is facing a $290 million Medicaid account deficit, and
Democratic Gov. Ned Lamont proposed doing away with a 2023
requirement that Medicaid cover GLP-1s for severe obesity, though
the state has never fully abided by the law due to the cost.
Starting June 14, though, state Medicaid patients will be required
to have a Type 2 diabetes diagnosis to get the drugs covered. Lamont
also is pushing for the state to cover two less expensive oral
medications approved by the FDA for weight loss, as well as
nutrition counseling.
Sarah Makowicki, 42, tried the other medications and said she
suffered serious side effects. The graduate student and statehouse
intern is working on a bill that would restore the full GLP-1
coverage for her and others.
Sara Lamontagne, a transgender woman with a disability who is on
Medicaid, said she regained weight when her coverage for GLP-1
medication was cut off in the past. She said she went from 260
pounds to over 300, heavier than she had ever been.
“So, it’s a horrible game to be played, to be going back and and
forth,” said Lamontagne, whose attempts to appeal the state's recent
denial of her Ozempic prescription refill have been unsuccessful.
Makowicki said GLP-1 drugs combined with weight-loss surgery helped
her change her life: She's had knee-replacement surgery and lost
over 200 pounds.
“I am a different person from what I was five years ago,” Makowicki
said. “Not only in my physical space, but also mentally.”
___
Haigh reported from Hartford, Connecticut. Levy reported from
Harrisburg, Pennsylvania.
All contents © copyright 2025 Associated Press. All rights reserved
 |
