Medicaid & Weight Loss Drugs: Ozempic, Wegovy, Mounjaro Coverage

Maryland lawmakers are debating a bill that would allocate an additional $449 million to Medicaid funds, potentially expanding coverage for weight-loss medications and related treatments, despite a $1.4 billion state budget shortfall. The proposal, set forward by Senate Minority Leader Steve Hershey, aims to broaden access to drugs like Ozempic, Wegovy, and Mounjaro, as well as intensive behavioral therapy and bariatric surgery for individuals with obesity.

Currently, Maryland Medicaid covers these weight-loss drugs only for patients diagnosed with obesity and co-existing health conditions such as sleep apnea or cardiovascular disease. Hershey argues that wider coverage is a preventative measure that could lead to a “healthier population” and ultimately reduce overall healthcare costs. He cited evidence suggesting that weight loss can decrease the incidence of related diseases like diabetes and hypertension.

“This is on the lines of preventative care,” Hershey stated during a Senate floor debate. “People with obesity are more prone to have other diseases… There has been evidence that shows that as people lose weight, those types of comorbidities decrease.”

The proposed expansion would cover any medication approved by the U.S. Food and Drug Administration (FDA) for obesity treatment. However, the substantial financial commitment has drawn scrutiny, particularly as the state grapples with a significant budget deficit. Democratic Senator Arthur Ellis raised concerns about the potential impact on Marylanders, noting that federal Medicaid spending is projected to decrease by approximately $1 trillion over the next decade.

The debate in Maryland reflects a broader national discussion regarding Medicaid coverage of weight-loss drugs. According to GoodRx, whether Medicaid covers these medications varies significantly by state, as Medicaid is a joint federal and state program. A recent report from POLITICO highlighted that while doctors are increasingly prescribing drugs like Ozempic, Wegovy, and Zepbound, Medicaid officials in many states are hesitant to cover them, potentially missing opportunities to address related health issues like cancer, diabetes, and heart disease.

In Ohio, the Department of Medicaid provides coverage for both prescription and over-the-counter drugs, with resources available to assist providers and members determine specific coverage details. The Maryland bill’s passage remains uncertain, and the potential financial implications for the state’s Medicaid program are still under review.