Covering GLP-1’s; Its Good Business

As a business leader, I know each move my company makes must be done with the future in mind. Over the years, I’ve learned a lesson that many ignore: making decisions with an eye on tomorrow can set the stage for long-term success.

Our policymakers should approach legislation the same way – investing in a healthier, more prosperous tomorrow rather than taking shortcuts today.

Right now, legislators in Harrisburg are considering whether Medicaid should cover FDA-approved obesity medicines. As they weigh this decision, they should consider the long-range financial implications. Though it may feel like denying coverage will save some cash in the short-term, the long-term benefits of accessible weight loss medicines will protect Pennsylvania’s economic future – and its health.

Let’s start with a plain fact. Obesity isn’t a choice – it’s a chronic disease. Left untreated, obesity increases the risk of several costly health issues like cardiovascular disease, hypertension, and type 2 diabetes.

Now, here’s another truth. Healthcare costs are about $2,500 higher for those who are obese than for those who are not. In Pennsylvania, the problem is particularly worrisome. Roughly 1 in 3 adults in the Commonwealth live with obesity. These aren’t just statistics that can be pushed aside. These are our parents, friends, neighbors, coworkers, and children struggling with a disease we cannot ignore.

Pennsylvania decided to restrict Medicaid coverage when projected costs for the Commonwealth and participating health plans were significantly higher, and the potential eligible population was much larger. However, instead of loosening those restrictions when projected coverage costs declined, Pennsylvania went the opposite direction – tightening eligibility requirements and raising the obesity coverage threshold for patients from a body mass index (BMI) of at least 30% to 35%.

When the forecast changed in Pennsylvania, coverage policy should have changed with it. Instead, legislators doubled down on bad policy and made it significantly more difficult for lower-income patients in the Commonwealth to obtain obesity care.

As a CFO, I make difficult financial tradeoffs every day. Managing budgets, workforce costs, and long-term financial planning in a highly competitive economic environment can be extremely difficult. However, preventing a problem is always less expensive than managing the consequences.

We know that obesity can often become a catalyst for numerous other life-threatening conditions, including diabetes, heart disease, and cancer. These comorbidities are the biggest drivers of healthcare spending, totaling over $1 trillion per year.

While some critics write off obesity care as a luxury good we can’t afford, the long-term cost of treating obesity-related illnesses is considerably higher than the cost of reducing obesity itself. If we want to successfully reduce healthcare costs, we need to change how we view this debate. 

GLP-1 medicines are among the most significant public health breakthroughs of this century, with an estimated 12% of adults in our country taking them for weight loss. If we want to improve health outcomes and reduce health disparities in Pennsylvania, we need to expand access to obesity treatments rather than restrict them. Removing hurdles to GLP-1 medicines will not only improve Pennsylvanians' health but also drive savings for state health plans for decades to come.

Policymakers should ensure Medicaid coverage decisions enhance patient outcomes and promote long-term value. Smart investments in health will protect Pennsylvania's economic competitiveness, preserve taxpayer resources, strengthen the Commonwealth’s workforce, and avoid saddling the state with more spending on avoidable disease.

Gov. Shapiro and the General Assembly should rethink the restrictions on Medicaid coverage for anti-obesity medicines. And policymakers must ask themselves a simple question: do we invest in preventing illness today or spend heavily to treat disease tomorrow?

The choice for lawmakers is clear.