Pennsylvania Medicaid spent nearly $300 million on Wegovy and other anti-obesity drugs

Pennsylvania Medicaid insurers spent nearly $300 million on Wegovy, Zepbound, and other new anti-obesity drugs in the year that ended Oct. 31, according to a new analysis from Real Chemistry, a New York health-care communications and marketing firm.

The total works out to $106 per Medicaid beneficiary, which is the third-highest total among 36 states with at least partial coverage of so-called GLP-1 drugs, which started as a treatment for diabetes. The drugs help regulate body sugar and lead to weight loss.

Pennsylvania’s total spending on the drugs was $298 million. That ranked second in the nation, behind California’s $1.4 billion total, Real Chemistry reported Tuesday. California’s spending per beneficiary was $118. Medicaid is a joint state and federal insurance program for low-income individuals and families that allows states discretion in what they cover.

» READ MORE: Litigation over anti-obesity drugs has been consolidated in Philadelphia.

Both California and Pennsylvania had year-over-year increases in the 230%-range, according to Real Chemistry. Kentucky had the highest spending per enrollee, at $162, but only pays for Wegovy for weight loss.

Pennsylvania is among 14 states that covers not just Wegovy, but also Zepbound and Saxenda. The state’s Medicaid program also covers Ozempic, Mounjaro, and Rybelsus, Real Chemistry said. These drugs have FDA approvals only for diabetes, but are often used for weight loss.

Pennsylvania began covering Wegovy in August 2023 and later added Saxenda and Zepbound to its preferred list of weight-loss drugs, according to the Pennsylvania Health Law Project, a legal aid organization with offices in Philadelphia that helps people navigate health insurance.

The nonprofit, known as PHLP, noted that Medicaid coverage of the weight-loss drugs is only available to people who also have Medicare, the government-sponsored insurance for people 65 and older. Adults also have to meet other conditions, such as having a body-mass index of at least 30 and at least one weight-related health problem.

In late November, the Biden administration proposed a rule change that would require Medicare and Medicaid to cover the anti-obesity drugs for people who are obese even if they don’t have diabetes. The rule change would classify obesity as a chronic condition.

There’s not enough time for the change to happen, though, before Biden leaves office.