As the demand for weight-loss medications rises, state Medicaid programs are grappling with whether to extend coverage for these treatments, with many weighing the potential benefits against the high costs associated with the drugs.
GLP-1 medications, originally developed for Type 2 diabetes, have gained popularity for their weight-loss effects. Drugs like Ozempic, Wegovy, and Zepbound help regulate blood sugar levels and reduce hunger by signaling the brain. While these treatments have proven effective for patients with obesity, their high costs—ranging from $940 to $1,350 per month—pose a barrier for many, particularly those on Medicaid.
Dr. Sarah Ro, a weight management physician at the University of North Carolina Physicians Network, has seen firsthand how these drugs could help patients who struggle with weight loss despite their best efforts. Many of her patients, who are often on Medicaid, battle obesity-related health issues that seem insurmountable. “They have a tremendous amount of disease burden,” Dr. Ro said, emphasizing the complications linked to obesity, including heart disease, diabetes, and sleep apnea.
In response to the increasing demand for GLP-1 drugs, North Carolina became the latest state to offer Medicaid coverage for the treatment of obesity in select populations. The state joins a growing list of 13 others, including California, Michigan, and Pennsylvania, which have incorporated GLP-1 drugs into their Medicaid programs. Kody Kinsley, the former secretary of North Carolina’s Department of Health and Human Services, expressed that providing coverage was a moral and financial imperative. He argued that investing in these drugs could reduce the long-term costs of obesity-related healthcare, which amounts to roughly a billion dollars annually in the state.
However, while coverage expansion could potentially lead to savings in future healthcare costs, experts like John Cawley, a professor of economics at Cornell University, caution that the immediate cost savings may not be significant for patients with a BMI under 40. He explained that while treating obesity could significantly reduce healthcare costs for patients with more severe obesity, for those with a BMI closer to 30, the savings may not offset the high cost of the drugs.
The rising interest in GLP-1 medications is also rooted in health equity concerns. State officials are increasingly considering the ethical imperative of providing equal access to effective treatments for marginalized communities. Yet, many states are hesitant to expand coverage due to the financial strain it would impose on Medicaid budgets. According to the Kaiser Family Foundation (KFF), Medicaid spending on GLP-1 drugs has surged from $597 million in 2019 to $3.9 billion in 2023, with much of this increase attributed to obesity treatments.
Despite these concerns, Kinsley emphasizes that obesity is a recognized medical condition, and the societal stigma around it often leads to reluctance in funding treatments. “It is my experience that the only time we seem to really get up in arms about the cost of a drug is when it is for some sort of stigmatized disease,” Kinsley said.
In North Carolina, the obesity rate is alarmingly high, with 70% of residents classified as overweight or obese. The state’s popular food culture, which includes high-fat, high-sugar dishes, and a lack of accessible healthy foods, contribute to this epidemic. Obesity is particularly prevalent among racial and ethnic minorities, with 48% of Black North Carolinians and 38% of Indigenous residents affected.
To address this, the Biden administration has proposed a rule to require Medicaid and Medicare to cover GLP-1 drugs for weight loss. However, this proposal is still under review, with an estimated cost of $11 billion for Medicaid coverage over the next decade, and an additional $3.8 billion for states.
Dr. Ro, who advocates for broader access to GLP-1s, believes that the drugs could be a life-saving intervention for patients with serious comorbidities like heart disease and liver disease. While not a universal solution, she sees GLP-1 medications as a critical option for those most at risk.
As states and federal authorities continue to assess the potential of GLP-1s to combat obesity, the ongoing debate over their Medicaid coverage highlights the intersection of healthcare equity, financial sustainability, and public health priorities.
Related Topics:
