Louisiana legislators may not have learned their lesson as they try to put taxpayers on the hook for a new Medicaid benefit that may end up causing any or all of wasted money, much higher expenses, and potentially avoidable harm to recipients.
Last year, a line item tucked into the state’s general appropriation bill would have made funding available to give semaglutide, a receptor agonist for human glucagon-like peptide-1 which is the basis for several drugs such as Wegovy, Ozempic, Monjauro, and Rybelus, to state employees that suffered from obesity. Republican Gov. Jeff Landry vetoed that.
And wisely so, for the monthly injections would have imposed a tremendous cost that must continue for effectiveness to kick in and stay in. Lifestyle changes, of which Landry has signaled at least indirect support for through his healthy eating initiatives, would just as effective if not even more so for weight loss and shedding of problems related to obesity. It would cost the state little to engage in campaigns urging personal responsibility to eat right and less, and to exercise more.
However, the idea has returned and even expanded. SB 433 by Democrat state Sen. Gerald Boudreaux, which he brought on behalf of the American Diabetes Association, would allow Medicaid adults classified as Class 2 obese (but not those defined as severely obese) free access to the semaglutide drugs as long as they also had a co-morbidity. Currently, Louisiana Medicaid already covers such drugs for those who suffer weight gain as an outcome of a chronic condition, but this would cover conditions that could be a consequence of obesity.
Until recently, data indicated this would cost state taxpayers upwards of $55 million a year. But the Republican Pres. Donald Trump Administration has jawboned these drugs’ manufacturers to offer steep discounts which could drop the state’s cost to a fifth of that, which in financial terms could make the deal much more possible. The amended version also includes a disclaimer that it would operate only if the Legislature made a specific appropriation.
But even that doesn’t justify putting this into law. The real problem lies not with money, but the speculative nature over the long haul of the drug’s effects. Chemically, semaglutide is much like, but not identical to, the naturally-occurring GLP-1, manifested principally in that the former spends far longer – about 10,000 times longer – in the body. As yet, there have been no long-term studies of the drug, but even the shorter-term efforts have revealed some problems, such as digestion-related ailments, nutritional deficiencies and muscle loss, and increased osteoporosis and gout. As well, initial research raises the possibility that discontinuing the drug can have negative cardiovascular implications, which the bill mandates if there is enough improvement.
(There are two other alternatives to semaglutide: tirzapatide and liraglutide. However, both also intervene with the GLP-1 receptor, which carries the same questions marks as a result.)
Medicaid could save money from not having to treat obesity complications, such as prediabetes moving to its full-blown version, that could exceed the costs of the drug, as well as having healthier residents. Yet lifestyle changes could do the same without exposing users, subsidized by taxpayers, to the risks not yet fully evaluated over the long term after usage, whether briefly or for a sustained period.
If the bill continues, for this reason Landry may have to play goalie again and block this attempt that has yet to acquire enough justification to make taxpayers cough up dollars that counterproductively could make the health of some recipients worse, aside from the fact that solutions involving less taxpayer expense but greater fortitude among intended recipients remain available and best for now.
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