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Liz Williams, one of many report’s authors and a senior coverage supervisor for the Program on Medicaid and the Uninsured at KFF, stated she was not conscious of some other state Medicaid applications becoming a member of the record since then. Wanting forward, the remaining states could also be reluctant so as to add a brand new, costly drug profit whereas they brace for potential federal cuts coming from Congress, she stated.
“As the budget debate, federally, is developing, that may impact how states are thinking about this,” Williams stated.
The federal authorities will not be serving to anytime quickly, both. Medicare covers GLP-1s to deal with diabetes and another well being situations, together with obstructive sleep apnea and heart problems, however not weight problems.
In early April, the Trump administration introduced it won’t finalize a rule proposed by the Biden administration that might have allowed an estimated 7.4 million folks lined by Medicare and Medicaid to entry GLP-1s for weight reduction. In the meantime, the FDA is poised to pressure inexpensive, compounded variations of those medication off the market.
And the barrier to entry stays excessive, even for Medicaid sufferers in these few states which have agreed to cowl the medication with no federal mandate.
Working example: In South Carolina, the place greater than one-third of all adults, and almost half of the African American inhabitants, qualify as overweight, the state Medicaid company estimates only one,300 beneficiaries will meet the stringent conditions for GLP-1 protection.
Below a kind of necessities, Medicaid beneficiaries who want to entry these medication to drop extra pounds should attest to “increased exercise activity,” stated Jeff Leieritz, a spokesperson for the South Carolina Division of Well being and Human Companies.
Novo Nordisk, which manufactures Wegovy, introduced in March that it was slicing the month-to-month worth of the drug from $650 to $499 for cash-paying prospects. The worth that medical health insurance plans and beneficiaries pay for these medication varies, however some GLP-1s value greater than $1,000 per affected person monthly, and many individuals might want to take them for the remainder of their lives to take care of weight reduction, stated Kenneth Mitchell, medical director for bariatric surgical procedure and weight problems medication at Roper St. Francis Healthcare.
And the North Carolina State Well being Plan Board of Trustees voted final 12 months to finish protection of GLP-1s for state workers, after then-North Carolina Treasurer Dale Folwell’s workplace estimated in 2023 that the medication had been projected to value the State Well being Plan $1 billion over the following six years.
The choice got here just a few months after a separate North Carolina company introduced it could begin masking these medication for Medicaid beneficiaries. North Carolina Medicaid has estimated it would spend $16 million a 12 months on GLP-1s.
South Carolina Medicaid, which insures fewer than half the variety of folks enrolled in North Carolina Medicaid, anticipates spending much less. Leieritz estimated GLP-1s and vitamin counseling provided to Medicaid beneficiaries in South Carolina will value $10 million a 12 months. State funding will cowl $3.3 million of the expense; the rest will probably be paid for by matching Medicaid funds from the federal authorities.
In a current interview, Well being and Human Companies Secretary Robert F. Kennedy Jr. did not rule out the chance that Medicare and Medicaid may cowl GLP-1s for weight problems remedy sooner or later as prices come down.
In the meantime, public well being specialists have applauded South Carolina Medicaid’s resolution to cowl GLP-1s. But the brand new profit will not assist the overwhelming majority of the 1.5 million adults in South Carolina who’re categorized as overweight, in accordance with information revealed by the South Carolina Division of Public Well being.
“We still have some work to do,” acknowledged Brannon Traxler, the general public well being division’s chief medical officer.
However the state’s new “Action Plan for Healthy Eating and Active Living,” written by a coalition of teams in South Carolina, together with the Division of Public Well being, makes no point out of GLP-1s or the function they may play in reducing weight problems charges within the state.
The motion plan, underwritten by a $1.5 million federal grant, is not meant to put out an overarching method for reducing weight problems in South Carolina, Traxler stated. As an alternative, it promotes bodily exercise in colleges, vitamin, and the growth of outside strolling trails, amongst different methods. A extra complete weight problems plan may handle the advantages of surgical intervention and GLP-1s, however these additionally carry danger, expense, and unwanted side effects, Traxler stated.
“Certainly, I think, there is a need to bring it all together,” she stated.
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Trump will not pressure Medicaid to cowl GLP-1s for weight problems: A couple of states are doing it anyway (2025, Might 28)
retrieved 28 Might 2025
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