By Amina Niasse
NEW YORK (Reuters) – Most U.S. states don’t at present cowl extremely wanted weight-loss medication from Novo Nordisk (NYSE:) and Eli Lilly (NYSE:) of their Medicaid well being packages for low revenue individuals, citing value as a key issue, based on a survey carried out by well being analysis agency KFF.
The survey of the 50 states and the District of Columbia discovered that simply 12 Medicaid packages coated the medication to deal with weight problems as of July 2024 with some limits on use.
Half of the states with out protection stated they’re contemplating including them or evaluating their protection, it stated.
The medication from a category often called GLP-1 agonists have been initially developed to deal with sort 2 diabetes but additionally promote weight reduction by suppressing starvation. Novo’s Wegovy and Lilly’s Zepbound record for round $1,000 monthly, although most individuals pay much less by way of medical health insurance or different drug firm reductions.
Protection of the medication by industrial plans can be restricted. The Medicare program for individuals aged 65 and older has stated that GLP-1 medication could also be coated for diabetes and heart problems after research revealed coronary heart advantages.
The survey discovered that state Medicaid packages count on their well being plan spending to extend by 7% in fiscal 2025, slowing from the 19% improve this yr as membership decreases. The fiscal yr ends for many states within the survey on June 30.
The decrease spending improve from a yr in the past follows termination of a coverage requiring insurers to maintain members enrolled in the course of the COVID-19 pandemic and the expiration of some federal funding.
Medicaid prices are paid by states and by the U.S. federal authorities. Complete spending on Medicaid rose 5.5% in fiscal 2024 and is predicted to extend 3.9% in fiscal 2025.
Medicaid membership re-determinations have decreased enrollment from a peak of 94 million in April of 2023. There have been some 71 million on its rolls forward of the pandemic. As of August, 4 states have been nonetheless re-determining Medicaid eligibility.
State Medicaid packages count on memberships to say no by round 4.4% in 2025 from a 7.5% lower in 2024, KFF stated.
Elevated prices of suppliers, managed care, medical advantages and prescribed drugs have been key drivers of spending, based on the survey findings.
Three quarters of the states are exploring at the very least one new or expanded initiative to comprise prescription drug prices in 2024 or 2025, KFF discovered.