Low-income residents in Pennsylvania may lose access to popular weight-loss medications such as Ozempic and Wegovy under proposed changes to the state’s Medicaid program. The administration of Governor Josh Shapiro is reviewing eligibility criteria for these drugs as part of its 2025-26 budget strategy, citing rapidly rising healthcare costs.
A spokesperson for the Pennsylvania Department of Human Services (DHS) said the current cost of GLP-1 medications, which include semaglutide-based drugs like Ozempic and Wegovy, has led to unsustainable spending. Originally developed to manage blood sugar in people with Type 2 diabetes, GLP-1 drugs are now widely used for weight loss due to their ability to suppress appetite.
In its budget draft, the state noted that spending on these medications is projected to approach \$1 billion and that changes are necessary to reduce the healthcare system’s reliance on high-cost prescriptions. Under the proposal, Medical Assistance would only cover GLP-1s for weight loss if recipients meet specific criteria, such as a high body mass index or having certain health conditions like heart failure or hypertension.
The proposed policy, which is set to begin on July 7, aims to prioritize access for patients at highest risk for complications. According to DHS, those at lower risk would be directed toward non-GLP-1 treatment options. Coverage for GLP-1 prescriptions for diabetes or pre-diabetes will remain unchanged.
Pennsylvania is one of 13 states that currently include GLP-1s in Medicaid coverage for obesity treatment. Other states include California, Michigan, Virginia, and Wisconsin. While some lawmakers support reducing costs, critics argue the plan could limit access to essential care for many patients.
Dr. Val Arkoosh, Secretary of the Pennsylvania DHS, said the department is reviewing medical necessity guidelines to ensure medications are prescribed to those who need them most while managing expenses responsibly. Nutrition expert Dr. Colleen Tewksbury of the University of Pennsylvania warned that the proposed restrictions could prevent eligible individuals from accessing one of the most effective treatments for obesity. She noted that the cost per patient is not rising, but increasing demand is driving up overall spending.
Tewksbury also expressed concern about the potential long-term consequences. She explained that discontinuing medication often leads to weight regain and associated health problems. While higher-weight individuals may still have access to alternatives like bariatric surgery, others with lower body weights may find themselves without viable treatment options.
The Shapiro administration faces growing pressure from a bipartisan group of state lawmakers who argue that instead of limiting coverage, the state should negotiate lower drug prices to maintain access for those who need it.
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