HARRISBURG \u2014 Thousands of low-income Pennsylvanians will face new barriers to weight-loss drugs like Ozempic under a move quietly announced by the Shapiro administration last month that\u2019s projected to save the state hundreds of millions of dollars.<\/p>\n
However, opponents argue maintaining wide access to the drugs produces greater savings by reducing obesity rates and lowering the risk of related conditions like heart disease.<\/p>\n
\u201cWe say that we want to prevent severe illness,\u201d state Rep. Arvind Venkat (D., Allegheny), also an active emergency physician, told Spotlight PA. \u201cAnd unfortunately this is an example where we are restricting access in a way that will likely lead to more severe illness and less health and well-being among our fellow Pennsylvanians.\u201d<\/p>\n
Since 2023, the state has paid for Medicaid patients\u2019 weight-loss treatment with these drugs, known as GLP-1s. The planned change, which takes effect Jan. 1, will mean they won\u2019t be covered solely for weight loss and obesity.<\/p>\n
The announcement<\/a> also came less than two weeks after Democratic Gov. Josh Shapiro and state lawmakers agreed to a four-month-late budget deal<\/a> in which state spending was a key disagreement.<\/p>\n Established in the 1960s, Medicaid is a program administered by the state and partially funded by the federal government to provide health insurance to low-income individuals and families. Known as Medical Assistance in the commonwealth, it covers approximately 3 million Pennsylvanians right now at a cost of billions in state dollars each year.<\/p>\n Some 70,000 of those patients were prescribed GLP-1s for any reason, the Department of Human Services previously told Spotlight PA<\/a>. The news organization in June reported that access to these drugs was a topic on the table in budget talks.<\/p>\n Originally developed to treat diabetes, in recent years GLP-1s have been prescribed for weight-loss. This led to an explosion in demand \u2014 and cost \u2014 for the drugs.<\/p>\n Pennsylvania spent $223 million on GLP-1 prescriptions for diabetes treatment for Medicaid recipients in 2022, the year before they were approved for weight-loss, DHS told Spotlight PA earlier this year. Just two years later, in 2024, prescriptions cost the state $650 million, and were projected to double this year.<\/p>\n Shapiro proposed ending obesity coverage in his budget proposal this year. This would limit state costs, as DHS Secretary Val Arkoosh told<\/a> House lawmakers during spring budget hearings. She said the administration wanted to ensure the drugs \u201care used appropriately by those who need it most.\u201d<\/p>\n Under the new policy, the commonwealth still will pay for GLP-1s to treat diabetes and a handful of other conditions, but how many patients that covers is unclear. DHS provided cost estimates from the policy shift, projecting the state will save about $380 million from now through the end of the next fiscal year.<\/p>\n Medicaid recipients who continue to qualify for coverage will have to go to their provider, receive a prescription, and then have that script reauthorized to continue their GLP-1 treatment.<\/p>\n The governor\u2019s office did not reply to an additional request for comment on the coverage cut. But Pennsylvania isn\u2019t alone in pursuing the policy shift.<\/p>\n At least three other states \u2014 California, New Hampshire and North Carolina \u2014 have recently limited or plan to throttle access to GLP-1s for weight-loss, according to health policy think tank KFF<\/a>.<\/p>\n The reduction, KFF found, is \u201clikely reflecting recent state budget challenges and the significant costs associated with coverage.\u201d<\/p>\n Medicaid cuts within President Donald Trump\u2019s omnibus tax and spending bill \u201ccould further exacerbate existing cost concerns,\u201d KFF\u2019s survey found<\/p>\n (On the federal side, the Trump administration has sent mixed signals<\/a> on GLP-1s, walking back<\/a> a planned public coverage expansion in the spring but cutting a deal with drugmakers to expand Medicare access<\/a> in the fall.)<\/p>\n Still, the cost pressure of these drugs is acute in Pennsylvania, where lawmakers needed 135 extra days to cut a budget deal in part due to the state\u2019s increasingly tough financial picture.<\/p>\n Senate Republicans repeatedly said they want to curb spending, both in the lead up to the June 30 budget deadline and during the public debates throughout the impasse.<\/p>\n Speaking to reporters in mid-June, state Senate Majority Leader Joe Pittman (R., Indiana) said that addressing rising Medicaid costs was a \u201cfundamental pillar\u201d of budget talks, and that absent any constraints on those costs growth, \u201cthere’s not going to be a lot to talk about.\u201d<\/p>\n While You\u2019re Here<\/p>\n Spotlight PA\u2019s nonprofit reporting is a free public service, but it depends on your support. Give now to ensure it can continue.<\/p>\n For his caucus, the coverage reduction is a key victory.<\/p>\n In a statement last week, Pittman added that \u201clooking for ways to save taxpayers money while continuing to provide core government services was a critical part of the final budget agreement.\u201d<\/p>\n The caucus projects the savings from reducing GLP-1 coverage will be lower than the Shapiro administration\u2019s estimates. Still, combined with other tweaks to the state\u2019s human services programs, the state will save more than half a billion dollars this year, Republicans predict.<\/p>\n For legislative Democrats, the reduction in health care access wasn\u2019t as welcome. In a statement last week, state Senate Minority Leader Jay Costa (D., Allegheny) said the change was due to the \u201cthe economic realities of our commonwealth and the chaos coming out of Washington.\u201d<\/p>\n \u201cOur caucus will be keeping a close eye on the impact of these decisions as we move forward, and we will continue our fight to ensure every Pennsylvanian gets the care and medication they need,\u201d Costa added.<\/p>\n (A House Democratic spokesperson’s only comment was that the change was made \u201coutside of the budget process.\u201d)<\/p>\n