As of September, the average cost of Ozempic, a leading GLP-1 drug, was about $997 per month without insurance. This cost has spurred debates about how state governments and Medicaid programs should respond to rising demand for these medications.
In the latest edition of “State of Play,” a bipartisan video series created by A Starting Point and NCSL, North Carolina Sen. Jim Burgin (R) and Colorado Sen. Dafna Michaelson Jenet (D) discuss issues states face when it comes to the use of GLP-1s .
The Medicaid Debate: Should GLP-1 Drugs Be Covered?
A 2024 study by KFF revealed that covering GLP-1 drugs for obesity under Medicaid could significantly expand access, benefiting nearly 40% of adults and 26% of children with obesity on Medicaid. However, Medicaid coverage for these drugs remains limited, with only 13 states offering coverage as of August 2024, while Medicare prohibits it entirely.
Burgin cautions about the potential budgetary impact of expanding Medicaid coverage for GLP-1 drugs. “We have a lot of people on Medicaid that are obese,” he says. “We’re spending a lot of money on their health." North Carolina halted the use of GLP-1s for weight managament under Medicaid as of Oct. 1, due to a lack of funding. “It was blowing the budgets out of sight,” he adds, noting cost reductions are needed to make such coverage feasible. He says prices should fall to “a few hundred dollars per month,” rather than thousands.
Michaelson Jenet, however, views Medicaid coverage as essential. “Our obesity rates are higher for those on Medicaid, and we know that handling obesity handles other comorbidities, and we could see a decrease in the overall expense of that patient at the benefit of their health,” she says.
Affordability and Pricing Concerns
Affordability remains a significant barrier for many Americans. A 2024 survey by Evercore I.S.I. found that willingness to pay for GLP-1 drugs varies widely based on income. For instance:
- 60% of people earning $250,000 or more annually are willing to pay up to $300 per month.
- 64% of those earning less than $75,000 annually are only willing to pay up to $50 per month.
With obesity rates disproportionately higher in low-income, rural and minority communities, lawmakers are debating how to ensure equitable access to GLP-1s and similar weight loss medications.
Michaelson Jenet stresses the importance of Medicaid in bridging these gaps. “The No. 1 thing we can do to make sure that low-income, rural communities of color don’t get left behind is to make sure that Medicaid is covering GLP-1s, and make sure that they have the information about that coverage so they know they have access to this life-changing medication.”
Burgin argues that addressing food choices and educational initiatives could also play a role. “I think a lot of it has to do with food choices by people on Medicaid,” he says, adding that they tend to buy cheaper, processed foods.
What Role Should States Play?
As GLP-1 drugs gain popularity, states are grappling with how to balance rising demand with budgetary constraints. Michaelson Jenet sees an active role for state governments in creating solutions. “The state is a great place to pass legislation, work with insurance companies, and work with the patient community to make sure they have access,” she says. “Otherwise, I don’t know who's fighting for them and getting them access.”
Burgin, on the other hand, believes states should focus on setting clear expectations and promoting personal responsibility. “If we’re paying for something for people, we need to set the rules,” he says. Government programs, he adds, should be more like trampolines than safety nets, helping people bounce back rather than keeping them stuck. “I want people off of government programs.”
This story first appeared in NCSL. Read the original here.
