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Gov. Kathy Hochul delivers her State of the State address at...

Gov. Kathy Hochul delivers her State of the State address at the Empire State Plaza Convention Center in Albany on Tuesday. Credit: Newsday/J. Conrad Williams Jr.

ALBANY — Gov. Kathy Hochul is proposing to increase access to popular diabetes medications such as Wegovy and Ozempic for use as weight-loss drugs by Medicaid, while lowering their high cost for all New Yorkers.

The cost to consumers for the medications can be $1,000 to $1,200 per month. The medications are more commonly covered by government health care and private insurance companies for cardiovascular disease, but not to fight obesity.

Hochul made a proposal that would expand use of the drugs in documents accompanying Tuesday's State of the State address. 

Hochul has directed the state health department to evaluate the level of access to the drugs classified as GLP-1 drugs, which could make the medications available to millions of Medicaid recipients. Hochul said she also would work with other states to leverage their combined purchasing power to reduce the cost of the drugs for all New Yorkers.

Details of the proposal are expected Tuesday when Hochul presents her 2025-26 budget proposal to the state Legislature. The health department on Wednesday didn’t immediately provide any specifics on the governor’s proposal.

Hochul’s proposal drew quick attention from health care insurers.

"These drugs have been groundbreaking and game-changing for folks struggling with their weight and the complications of health factors that come with it," said Eric Linzer, president and CEO of the New York Health Plan Association in an interview Wednesday.

"One thing to remember about these drugs is that in addition to the high cost, there is consideration of whether these drugs will provide any cost savings over the long term," Linzer said.

Independent studies have raised the question of how long most patients will keep off the weight they lose with the help of the drugs.

Linzer said private health insurers welcome the state’s review of the effectiveness of the drugs, but also want to see if Hochul is able to lower costs working with other states. He said there has been discussion of the state potentially mandating that private insurers provide coverage for policy holders who use the drugs.

"Health insurance costs in New York are already the highest in the country," Linzer said. "Mandating coverage for this whether through employer or individual coverage in the Medicaid program will have significant impact and make insurance for health care that much more unaffordable for New Yorkers."

Medicaid Matters New York, which lobbies for low-income and ill New Yorkers, didn’t immediately respond to requests for comment a day after Hochul announced her proposal.

The manufacturer of Ozempic and Wegovy is Novo Nordisk based in Denmark with offices in New Jersey. The company spent $72,107 over six months through December lobbying the Assembly’s Democratic majority and Hochul’s Division of Budget, according to state lobbying records. The topics were "anti-obesity medication coverage" and "Medicaid coverage of weight loss medications." The company also specifically lobbied for a bill in the Assembly with an objective of "requiring commercial insurance policies to provide comprehensive coverage for the treatment of obesity."

The bill didn’t pass the Assembly, but could be reintroduced this year.

The drug company contributed $3,500 to Hochul’s campaign since Dec. 5, 2023, according to state Board of Elections records.

The company didn’t immediately respond to a request for comment Wednesday.

GLP-1 medications, propelled by heavy advertising for Ozempic and Wegovy nationally, have already prompted action by other states and the Biden administration in Washington.

In 2024, Illinois passed a bill to cover GLP-1 weight loss and obesity medications for state workers under labor contracts with the state. However, the high cost has prompted opposition in some states, including North Carolina's decision to no longer cover the medications for weight loss, according to the National Conference of State Legislatures.

Thirteen states include coverage of the medications in their Medicaid programs for obesity, according to a survey by KFF, a San Francisco-based nonprofit health policy research organization. But the measures have mostly been limited to approving the medication for obesity in state workers’ health plans, according to NCSL.

In November, President Joe Biden proposed expanding coverage of the anti-obesity drugs under Medicaid and Medicare, which would cover the poor, working poor, elderly and infirm.

Medicare and Medicaid only cover the cost of the drugs for certain illnesses, such as diabetes. Biden’s proposed change would open the coverage to obesity, which could impact tens of millions of Americans. The White House said in a statement that  42% of the nation’s population that is obese.

If approved, Medicare coverage would reduce the cost for individuals by as much as 95% and 4 million people served by Medicaid would gain access to the drugs, according to the statement.

Whether the incoming Trump administration would be supportive is unclear. Robert F. Kennedy Jr., President-elect Donald Trump’s nominee to head the federal Department of Health and Human Services, has said in TV interviews that he’s not sold on drugs to control obesity, instead calling for proper diet. 

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