Particle.news

Download on the App Store

Cost Concerns Limit Medicaid Coverage of Weight-Loss Drugs

A recent survey reveals that most U.S. states do not cover obesity medications in Medicaid due to financial constraints, though some are reconsidering.

Boxes of Wegovy made by Novo Nordisk are seen at a pharmacy in London, Britain March 8, 2024. REUTERS/Hollie Adams/File Photo

Overview

  • Only 12 state Medicaid programs currently cover obesity drugs like Wegovy and Zepbound, with restrictions on their use.
  • Half of the states without current coverage are evaluating the possibility of adding these drugs to their Medicaid programs.
  • GLP-1 agonists, initially developed for type 2 diabetes, are priced around $1,000 per month but can be less expensive with insurance or discounts.
  • Medicaid spending is projected to rise by 7% in fiscal year 2025, driven by increased costs in healthcare services and pharmaceuticals.
  • State Medicaid enrollments are declining post-pandemic, with a 4.4% decrease expected in 2025 following policy changes and funding expirations.