By Dennis Thompson HealthDay Reporter<\/b>
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TUESDAY, Nov. 5, 2024 (HealthDay News) — Low-income patients’ access to blockbuster weight-loss drugs through Medicaid remains limited, a new KFF analysis has found.<\/p>\n
Only 13 states currently allow Medicaid to cover treatment of obesity using glucagon-like peptide-1 agonist (GLP-1) medications, researchers discovered.<\/p>\n
Under the Medicaid system, individual states are allowed to decide whether to cover GLP-1 drugs, which include Wegovy<\/a> (semaglutide), Zepbound<\/a> (tirzepatide) and Saxenda<\/a> (liraglutide), the KFF report<\/a> noted.<\/p>\n Among those states that don\u2019t cover the drugs, half reported that they are considering adding coverage in the near future, the researchers added.<\/p>\n But GLP-1 drugs are pricey, and nearly two-thirds of states said cost is a hurdle to approving coverage of the medications through Medicaid.<\/p>\n \u201cExpanding Medicaid coverage of these drugs could increase access for the almost 40% of adults and 26% of children with obesity in Medicaid,\u201d wrote the research team led by senior investigator Clea Bell<\/a>, a research assistant in state health reform for KFF. \u201cAt the same time, expanded coverage could also increase Medicaid drug spending and put pressure on overall state budgets.\u201d<\/p>\n GLP-1 receptor agonist drugs mimic the GLP-1 hormone, which helps control insulin and blood sugar levels, decreases appetite and slows digestion of food.<\/p>\n However, the drugs are costly — people without insurance face paying more than $1,000 a month to take them.<\/p>\n The 13 states where Medicaid covers GLP-1 drugs for obesity are California, Kansas, Minnesota, Wisconsin, Michigan, Mississippi, Pennsylvania, Virginia, North Carolina, Massachusetts, New Hampshire, Delaware and Rhode Island.<\/p>\n Both the number of Medicaid prescriptions for GLP-1 drugs and the amount spent on the drugs have skyrocketed in recent years, researchers found.<\/p>\n Between 2019 and 2023, the number of GLP-1 prescriptions increased by more than 400%, while spending increased by more than 500%.<\/p>\n There were about 3.8 million GLP-1 prescriptions covered by Medicaid in 2023, compared to 755,000 in 2019, results show. Gross spending on the drugs amounted to $3.9 billion in 2023, up from $597 million in 2019.<\/p>\n Despite these numbers, GLP-1 drugs account for relatively small shares of total Medicaid spending and prescriptions, the report noted — about 0.5% of all Medicaid prescriptions and 3.7% of gross Medicaid spending.<\/p>\n Further, about 40% to 62% of these costs are rebated to the government by the drug makers, according to estimates cited by KFF.<\/p>\n But the costs remain staggering enough to cause many states to think twice before expanding coverage to GLP-1 drugs, the researchers noted.<\/p>\n On the other hand, 40% of the states that do cover GLP-1 drugs — or are considering coverage — noted that the medications could ultimately save money by heading off the chronic diseases associated with obesity.<\/p>\n \u201cIn the longer term, however, reduced obesity rates among Medicaid enrollees could also result in reduced Medicaid spending on chronic diseases associated with obesity, such as heart disease, type 2 diabetes and types of cancer,\u201d the researchers noted in a KFF news release.<\/p>\n More information<\/strong><\/p>\n The Cleveland Clinic has more on GLP-1 drugs<\/a>.<\/p>\n SOURCE: KFF, news release, Nov. 4, 2024 <\/p>\n