Medical Assistance coverage of weight loss drugs can continue for now

What costs more money: Medical Assistance coverage of weight loss drugs or future coverage for comorbidities that stem from obesity?

As names like Ozempic, Wegovy and Mounjaro have gained popularity in recent years, Minnesota’s cost per Medical Assistance patient using these drugs surged, now costing $12,000 per person per year and representing more than 12% of the state’s pharmaceutical costs.

That’s alarming to Rep. Danny Nadeau (R-Rogers).

A bill he sponsors, HF4142, that would prohibit Medical Assistance coverage of prescription drugs solely used for weight loss, was laid over Wednesday by the House Health Finance and Policy Committee.

Rep. Danny Nadeau

The bill is not about whether obesity is a chronic disease that needs to be treated, Nadeau said. “This is about balancing the costs to our health care system with increasing cost trend on certain drugs.”

Many health care professionals, organizations and advocacy groups testified that access to weight-loss drugs is critical to long-term health outcomes.

This access is crucial to prevention and management of diabetes, wrote Erin Callahan, chief operating officer for the Diabetes Patient Advocacy Coalition. She cited a five-year study by the American Diabetes Association that shows the use of weight loss drugs reduces the risk of developing Type 2 diabetes by 94% in obese or overweight adults with pre-diabetes.

Dr. Claudia Fox, a University of Minnesota professor of pediatrics and co-director of the Center for Pediatric Obesity Medicine, agrees. “I acknowledge that the costs of these medications are high, but the cost of untreated obesity will be higher. I urge you to use your powerful voice to negotiate better prices with drug companies and PBMs, rather than forcing your constituents to lose evidence-based health care.”

Rep. Kristin Bahner (DFL-Maple Grove) said the bill is well-intentioned but short-sighted. “What we’re basically saying in this bill is we’re going to wait until you get sick. We’re going to wait until you have a whole list of comorbidities, and then we’ll let you lose weight when you could have addressed it on the front end.”