A class of drugs that are used in the treatment of type 2 diabetes and obesity are becoming increasingly popular as a weight-loss drug. However, the high cost of these GLP-1 drugs—the annual list price is around $12,000—has posed a dilemma for states as they decide whether to cover the drugs in their own state health plans, Medicaid and possibly require private insurers to cover the drugs. 

On this episode, we get perspectives from three people involved in the debate: Kristen Niakan, a pharmacy management consultant with the actuarial and consulting firm Milliman; North Carolina Treasurer Dale Folwell (R); and Colorado Senator Dafna Michaelson Jenet (D).

Niakan explained the background of these drugs, who's using them, the costs involved, and the insurance coverage landscape across the country. Folwell walked through the decision in his state not to cover GLP one drugs for the state's employee health plan, and also discussed a separate decision in his state to extend coverage of the drugs to Medicaid recipients. Michaelson Jenet discussed her efforts to pass legislation that would've required all private insurance companies and the state Medicaid program in Colorado to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including FDA approved anti-obesity medication. 

Resources

• Diabetes State Mandates and Insulin Copayment Caps, NCSL
• Employers feel the side effects of drugmaker control over Wegovy, Ozempic costs, Politico
• GLP-1 agonists in Medicaid: Utilization, growth, and management, Milliman
• Impact of anti-obesity medication coverage in the Medicaid and commercial markets
• KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 Drugs, KFF