State Medicaid programs are facing increasing pressure to cover top-selling anti-obesity medications as evidence of their effectiveness continues to grow. However, experts suggest that broader access will rely on lower list prices and greater support from the federal government.
The number of anti-obesity medications reimbursed by state Medicaid programs has risen significantly, from over 7,600 in 2011 to about 108,000 in 2022, according to a study published by JAMA. This study, conducted by researchers at Brigham and Women’s Hospital and Harvard Medical School’s Program On Regulation, Therapeutics, And Law, highlights the growing utilization of medications like liraglutide (Saxenda) and semaglutide (Wegovy) from Novo Nordisk A/S.
While 16 state Medicaid programs currently cover these weight-loss medications, the high list prices ranging from under $1,000 to over $1,300 per month have led some states to impose additional criteria for coverage. This is in response to increases in prescription drug spending for Medicaid programs reported by KFF since 2018.
To expand coverage to more low-income individuals covered by Medicaid, experts suggest implementing new payment models, increased manufacturer discounts, and more federal aid to states. Benjamin Rome, a health policy researcher at Harvard Medical School, emphasizes the need for a serious discussion on ensuring accessibility to these effective treatments for all patients.
Pressure on States
The demand for state Medicaid programs to cover anti-obesity drugs has grown as more effective medications have come to market. However, coverage for weight-loss medications has historically been limited due to perceptions of them being more cosmetic than medical. Recent approvals for drugs like Novo Nordisk’s Ozempic and Wegovy have shifted this mindset.
Although these treatments are highly effective with minimal side effects, most state Medicaid programs do not require coverage for anti-obesity medications, despite a significant portion of Medicaid enrollees being affected by obesity.
Coverage Limits
States currently face budgetary challenges in covering anti-obesity medications, leading to limitations on who qualifies for coverage. Some states impose restrictions even for those covered, determining access to name-brand drugs based on preferred formulary lists.
Despite the significant costs associated with obesity-related healthcare, access to weight-loss drugs remains limited in many states. As policymakers look toward broader coverage, potential solutions include alternative payment models and increased federal support.
Looking Ahead
As Medicaid programs consider expanding coverage for anti-obesity medications, exploring various solutions will be crucial. From outcome-based payment structures to seeking federal assistance, strategies to improve accessibility will require a multi-faceted approach.
While challenges like high list prices and limited generic competition persist, policymakers and analysts are optimistic about the potential for broader access to these essential treatments in the future.