Medi -Cal Coverage of Weight Loss Drugs Cutting Block As per CA – Calmatters suggestion

From Anna B. IbaraCalmness

This story was originally published by CalmattersS Register about their ballots.

Popular Ozmpic and Wegovy Weight Loss Medicines will no longer be covered by Medi-Cal according to a proposal discovered by the Gavin Newsom government on Wednesday in an attempt to reduce exceeding costs in the State Health Insurance Program.

Expensive medicines prescribed to combat obesity increase the cost of Medi-Cal, a state program that provides a health coverage for low-income Californians. Eliminating the coverage for these medicines would save the state $ 85 million in 2025-26 and up to $ 680 million by 2028-29, according to the governor.

Newsom’s proposal will be taken over by the State Legislative Body as the Governor and the best legislators deal with a state budget faced with a deficit of $ 12 billion.

As suggested, the medicines will be completed on January 1, 2026. Patients with Medi-Cal who are trying to lose weight will have to pay for the recipes themselves, with a price of over $ 1,000 a month, which makes it unattainable for low-income people.

Some healthcare professionals say that medicines are highly effective in combating obesity, a chronic illness that increases healthcare costs as it can lead to many other disorders such as heart disease and diabetes.

Approximately 18 million adults in California are obese or overweight, according to the UCLA Health Study Center.

“This is a bad solution. People who already take this medicine, what will happen to them?” Liz Helms, President of the California Coalition for Chronic Care, a group of organizations and healthcare suppliers, said.

The California Association of Health Plans said the Newsom proposal “must send a strong signal to the legislature that they should review, imposing that health plans cover these expensive weight loss medicines without the appropriate clinical precautionsS ”

California is not required by federal law to cover the cost of weight loss drugs in its Medi-Cal program. Instead, the state decided to include them. According to the proposed abbreviations of Newsom, when prescribed ozmpic for the treatment of diabetes, it will still be covered by Medi-Cal.

Newsom’s proposal comes when wegovy and ozmpic prescriptions among participants in Medi-Cal are increasing along with the overall cost of medical prescription drugs. During the fiscal year 2023-24 drugs cost Medi-Cal nearly $ 15.2 billionAccording to state reports on drug costs. This is about 10% increase compared to the previous year.

Between 2022 and 2023, Wegovy Prescriptions in the Medi-Cal program He jumped from 15,000 to 181,000, data from US Medicaid and Medicare Services centers show. Ozepki diabetes and weight loss recipes increased from 178,000 in 2022 to 480,000 in 2023.

In 2023, the last year for which data is available, Medi-Cal spent about $ 733 million for both medicines. (This amount does not include the recovery of the refund that Medi-Cal received from pharmaceutical companies as part of discount programs.)

“This is a bad solution. People who already take this medicine, what will happen to them?”

Liz Helms, California Coalition for Chronic Care

In his budget presentation today, Newsom did not mention drugs. But he said several restrictionsIncluding the freezing of Medi-Cal entries by people who do not have a permanent legal immigration status. Medi-Cal covers nearly 15 million Californians.

Earlier this year, the state had to fill the refusal of $ 6.2 billion in its Medi-CAL budget to pay suppliers by the end of June. The Ministry of Health, which runs the Medi-Cal program, cited a number of reasons for exceeding the budget, including the expansion of the state to undocumented immigrants and an increase in the cost of prescribed drugs.

Ozmpic is mainly used to treat type 2 diabetes, but some doctors also prescribe it for weight loss. Wegovy is only used for weight loss. Both are manufactured by the Danish pharmaceutical company Novo Nordisk and have no common versions.

Semaglutide, the active ingredient in both medicines, Works by imitating the hormone GLP-1which helps to regulate blood sugar and appetite. In an attempt to manage costs, already Medi-Cal limits the amount of Wegovy This can be distributed every 28 days to one carton of four pen injectors. Patients are injected once a week.

In order to qualify for Medi-Cal, one person’s annual income cannot exceed $ 21,597. For a 4 -threshold family is $ 44,367.

Erika Yes contributed to this report.

This article was Originally Published on CalMatters and was reissued under Creative Commons Attribution-Noncommercial-Noderivatives License.