Boxes of the diabetes medication Ozempic sit on a pharmacy counter in Los Angeles. Medications like Ozempic have become increasingly popular in the treatment of obesity, leading more than a dozen states to adopt them. But faced with enormous budget pressures, several state Medicaid agencies are either halting coverage entirely or restricting access to therapy. (Photo illustration by Mario Tama/Getty Images)
Some states are rethinking their reporting of GLP-1 weight-loss drugs as budgets tighten and Medicaid programs prepare for cuts included in President Donald Trump’s sweeping tax and spending bill.
From October 1st 16 state Medicaid programs Laut einer Umfrage unter Medicaid-Direktoren von KFF, einer Forschungsgruppe für Gesundheitspolitik, wurden GLP-1-Medikamente für die Behandlung von Fettleibigkeit abgedeckt, gegenüber 13 im letzten Jahr. However, some states have announced they will stop providing coverage or limit who can qualify for it.
Many doctors and patient advocates say the drugs will save money in the long run by reducing obesity-related diseases such as heart disease and diabetes. However, many states have concluded that they simply cannot afford them.
North Carolina Medicaid GLP-1 coverage has ended for obesity last month, citing shortfalls in government funding. California, New Hampshire and South Carolina have said they will end health insurance coverage on January 1st. Ab dem nächsten Jahr wird Michigan Medicaid die Krankenversicherung auf Menschen beschränken, die „krankhaft fettleibig“ sind. Pennsylvania, Rhode Island and Wisconsin are also considering fresh restrictions.
According to Elizabeth Williams, a senior policy manager at KFF who focuses on Medicaid, about half of states in last year’s KFF survey said they were interested in covering GLP-1 for weight loss. This year, most states are moving in the opposite direction.
This likely reflects recent state budget challenges and the significant costs associated with coverage.
– Elizabeth Williams, KFF senior political manager
“This likely reflects recent state budget challenges and the significant costs associated with coverage,” Williams said. “After several years of robust revenue growth in the immediate aftermath of the pandemic, states are beginning to experience declining revenues, increasing spending demands and significant financial uncertainty, due in part to recent federal actions.”
In April, the Trump administration scrapped a Biden-era proposal that would have required state Medicaid programs to pay for some GLP-1s to treat obesity. Earlier this month, Trump announced that his administration reached agreements with the makers of Wegovy and Zepbound to lower the prices of the drugs for Medicaid, Medicare and consumers who buy the drugs directly, but it is unclear whether the agreements were reached will reduce costs for states.
Health insurance companies for state employees are also currently reviewing coverage of anti-obesity medications. North Carolina, for example, ended GLP-1 obesity coverage for state employees last year, and West Virginia canceled a 1,000-person pilot program.
GLP-1 drugs that balance blood sugar levels have long been prescribed to patients with type 2 diabetes and cardiovascular disease. All state Medicaid programs, jointly funded by the states and federal government, cover GLP-1 for these uses.
The medication also curbs the feeling of hunger and can assist you lose significant weight. Drugs such as Ozempic, Wegovy and Zepbound are very popular for this purpose.
Between 2019 and 2023, the number of outpatient Medicaid prescriptions for select GLP-1 for the treatment of diabetes and obesity increased from 755,300 to 3.8 million. according to KFF. During the same period, Medicaid spending on these drugs increased from $597.3 million to $3.9 billion.
A study published last year The BMJ, the journal of the British Medical Association, found that the number of patients without diabetes starting GLP-1 treatment in the United States increased from about 21,000 in 2019 to 174,000 in 2023, or more than 700%.
More than 2 in 5 adults in the US suffer from obesity, according to the federal Centers for Disease Control and Prevention. The CDC defines obesity as a body mass index — a calculated measure of body weight in relation to height — of 30 or more. According to the agency, obesity costs the U.S. health care system nearly $173 billion annually.
Recently, the manufacturers of some GLP-1s and sell them directly to consumers for $500 or less per month. But many patients cannot afford to pay that much out of pocket.
States in a tough financial situation
In North Carolina, Dr. Jennifer McCauley, a weight management physician at UNC Health, said GLP-1’s Medicaid coverage has “helped our patients incredibly.”
“Now they’ve stopped health insurance, so these people are coming back and gaining some weight again because they’re not able to get these medications, and they’re also suffering the health consequences of obesity,” McCauley told Stateline.
Some critics of comprehensive GLP-1 reporting say this is not the case cost effectivebecause many patients regain the weight they lost after stopping treatment. But McCauley said the “downstream effects of obesity are even greater.”
“There are definitely vulnerable populations that probably wouldn’t be able to lose weight without these medications.”
James Werner, a spokesman for the North Carolina Department of Health and Human Services, blamed the coverage change on the state Legislature’s failure to provide enough money for Medicaid.
In an email to Stateline, Werner said coverage of GLP1 for weight loss “would be reconsidered if Medicaid were fully funded.”
According to Colleen Becker, a project manager at the National Conference of State Legislatures, a policy research group, some states are trying to at least partially cover the costly drugs by tightening eligibility requirements for a prescription.
“States are really thinking about how to balance access and provide that access to patients, but they are the stewards of their budgets and they also need to manage them well,” Becker said.
Michigan und Pennsylvania gehören zu den Staaten, die solche Optionen in Betracht ziehen. Meanwhile, Connecticut decided to maintain insurance coverage for weight-loss medications for state employees, but require beneficiaries to try online weight-loss counseling before they can get a prescription.
Some future possibilities
One state, North Dakota, took a different approach to GLP-1 coverage after a law required it Medicaid The drug coverage program failed. Instead, North Dakota this year became the first state to require insurers to cover weight loss medications in the state’s Affordable Care Act marketplace.
North Dakota Deputy Insurance Commissioner John Arnold said the insurance department calculated that the mandate would not result in a significant escalate in insurance premiums.
„Es ist nicht so, dass irgendjemand in die Arztpraxis gehen und sagen kann: ‚Hey, ich möchte, dass das abgedeckt wird’“, sagte Arnold. “It’s really intended for those who have a medical need for the medication, then it would be covered.”
According to Republican North Dakota House Speaker Robin Weisz, the insurance department had to ask lawmakers for permission for the change. He said insurance carriers were worried it would be “open season for anyone who could lose 20 or 30 pounds.”
“If the carriers can come in a few years and say, ‘Wow, that’s what we spent on this … then we’ll take a hard look at it,” Weisz said. „Aber es ist zum jetzigen Zeitpunkt noch viel zu früh, um das zu sagen.“
Arnold says other states may have the flexibility to require ACA insurers to cover the drugs.
“Our biggest concern has been reducing these comorbidities and the associated long-term impact on insurance costs in general, because more comorbidities mean more claims,” Arnold said, referring to diseases and conditions associated with obesity.
Stateline reporter Shalina Chatlani can be reached at shatlani@stateline.org.
This story was originally produced by State borderwhich is part of States Newsroom, a nonprofit news network that includes West Virginia Watch, and is a 501c(3) public charity supported by grants and a coalition of donors.
