States slow to cover GLP-1s for weight loss
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Budget pressures have kept all but 13 states from covering GLP-1 drugs for weight loss through their Medicaid programs, a new report from KFF shows.
Why it matters: The restrictive policies add to equity concerns around the blockbuster drugs, which have shown a remarkable ability to help patients lose weight and improve associated health metrics.
- More liberal Medicaid coverage could expand access for the almost 40% of adults and 26% of children with obesity in Medicaid, but would strain some state budgets.
The big picture: Most large employers also don't cover GLP-1 drugs for weight loss while there is limited coverage in Affordable Care Act markets, KFF said. Medicare prohibits coverage of the drugs for weight loss.
- However, coverage of GLP-1s for other health purposes such as preventing heart attacks has been growing rapidly, driving up health spending.
- Gross Medicaid spending on GLP-1s approved for diabetes as well as obesity jumped from $597.3 million in 2019 to $3.9 billion in 2023.
What they found: In all, a dozen states in KFF's annual budget survey — including California, Massachusetts, Michigan, Minnesota and Pennsylvania — reported covering GLP-1s for obesity treatment under their Medicaid fee-for-service programs as of July 1.
- North Carolina reported adding coverage in August.
- The analysis found 11 of the 12 states required some sort of utilization control such as prior authorization and/or a minimum body mass index requirement.
- 11 of the 12 states covered all three of the GLP-1s approved for treating obesity, including Novo Nordisk's Saxenda and Wegovy, as well as Eli Lilly's Zepbound.
The bottom line: More states are considering adding or expanding coverage of GLP-1 for obesity, but two-thirds surveyed said cost containment was a primary concern, KFF found.
- States are also considering factors such as concerns about adherence, the need for clinical criteria and potential side effects. Some are weighing whether coverage should be written into law.
