Pennsylvania lawmakers debate having Medicaid cover Ozempic, similar drugs

(WHTM) — Budget hearings are over at the State Capitol, but one particular expense involving a popular weight loss drug has caught the eye of Pennsylvania lawmakers.

The popular weight loss drug Ozempic and similar drugs have been the talk of the Pennsylvania Capitol recently. The topic came up during appropriations hearings with the Department of Human Services.

The Department of Human Services allows Ozempic and other GLP-1 drugs to be given to both people with diabetes and people looking to lose weight.

“So in the 2025 year, we have $1.3 billion for GLP-1’S,” answered Secretary Val Arkoosh.

Pennsylvania is 1 of 14 states that allow it to be used for weight loss only. While there isn’t much data to prove it saves money in the long run, it certainly costs a lot.

The Governor’s budget says the Department of Human Services will spend $1.2 billion on Ozempic-like drugs for Medicaid patients next year, and some lawmakers are questioning what should be covered under a government safety net program.

Senator Scott Martin (R-Lancaster), the Chair of the Appropriations Committee, said using Ozempic-like drugs for strictly weight loss purposes isn’t necessarily fair to taxpayers if it’s that costly.

“Using it as a means for just run of the mill ‘I want to lose some weight’ and if it’s that costly, I don’t think that’s necessarily fair to the taxpaying Pennsylvanians,” said Martin. “And certainly, I’m sure some of their private insurance plans don’t cover the same.”

Some Democrats feel differently about providing the medication at tax-payer cost.

“What I think is unfair is for folks to dictate what kind of medication folks should be able to take and not take,” said Rep. Jordan Harris (D-Philadelphia). “I think it is also unfair for folks who get to benefit from the medication themselves, from their health care, to then say that other people don’t deserve the same type of quality health care.”

The Department of Human Services is the biggest spender of state budget dollars. Shapiro proposed a $51 billion budget, of which the DHS would get $21 billion. Secretary Arkoosh says GLP-1s are proven to reduce long-term healthcare costs for diabetics. As for the others who are getting it?

“The use for obesity is less well proven in terms of actual cost savings,” said Arkoosh.

Arkoosh told the Senate she’ll recommend to the Oversight Board that only severe obesity cases get approved. Perhaps diet, exercise, and cheaper drugs are required first.

“We are taking a very hard look at how we are using these medications for obesity,” said Arkoosh. “We are going to present a new set of much more robust prior authorizations for them to consider and hopefully approve.”