Colorado Reverses Course on Weight Loss Drug Coverage Amid Growing Costs
Colorado has had a change of heart. After announcing plans to halt coverage of weight-loss medications like Wegovy for state employees, the state has decided to backtrack. Why the reversal? Pressure from lawmakers and the state employees’ union made it clear that cutting access wasn’t going to fly.
Starting July 1, though, employees will still feel the pinch. The copay for these medications is set to jump from $30 to $120. And new prescriptions for weight loss? Nope, they won’t be covered anymore. It’s all part of Colorado’s attempt to rein in the ballooning costs tied to these medications.
Skyrocketing Costs and Tough Choices: The GLP-1 Dilemma
State officials are dealing with numbers that are hard to ignore. The cost of providing GLP-1 drugs skyrocketed from $1.5 million in mid-2023 to $7 million by the end of 2024. For a state budget, that’s a tough pill to swallow. Medications like these aren’t cheap, and as more people turn to them for weight management, the bills keep piling up.
But Colorado’s not alone. States across the country are wrestling with how to manage soaring demand for these medications while keeping budgets intact. Some are taking the plunge, extending coverage under programs like Medicaid. Others? Not so much.
Take North Carolina. They’re all in, covering GLP-1 drugs for weight-loss treatment through Medicaid. Why? Analysts in the state argue it’s a smart long-term move. Obesity-related health issues, like diabetes and heart disease, tack on billions in healthcare expenses. By covering these drugs, North Carolina hopes to chip away at those costs over time.
Wisconsin and California are on board, too—but there’s a catch. Access often comes with strings attached, like BMI requirements or prior authorization. Not every applicant gets a green light.
Rising Costs and Federal Debate: Is Coverage Sustainable?
Still, not everyone thinks this approach is doable. Medicaid spending on GLP-1 drugs has shot up by more than 500% since 2019. That’s a jaw-dropping stat. For states already stretched thin, expanding coverage isn’t just a health debate. It’s a financial one.
Even at the federal level, the discussions are heated. The Biden administration floated the idea of mandating Medicaid and Medicare coverage for these medications. The price tag? A projected $11 billion over ten years. Supporters say it’s money well spent, but critics see it as a potential budget buster.
And then there’s the rest of the states. About half aren’t currently covering obesity drugs like Wegovy, although many say they’re “exploring options.” Some are looking into creative solutions, like negotiating rebates with pharmaceutical companies or offering integrated programs that pair medications with dietary counseling. Smart ideas—but not a quick fix.
Colorado’s Uncertain Path Forward
Back in Colorado, the debate is far from over. Yes, the state will keep covering weight-loss prescriptions for existing users, but slashing new prescriptions could still leave many frustrated. Lawmakers and public health advocates are watching closely. Will the cost-saving measures work? Or will these restrictions backfire, creating bigger health problems (and costs) down the road?
Time will tell. For now, though, Colorado’s plan is clear. Keep some coverage, hike up the copays, and cross their fingers that it’ll all balance out. Risky? Maybe. Necessary? That’s the big question.