Elected officials are looking to expand access to weight loss drugs like Ozempic and Wegovy for low-income Virginians as part of the 2025 legislative session.
A patient can lose as much as 20% of their body fat after a year on the drugs — a powerful weapon in the fight against the obesity epidemic. But high demand has led to high prices. Legislators must decide if the long-term health benefits are worth the cost.
The drugs are made of GLP-1, or glucagon-like peptide-1. It’s a molecule that’s produced in your body after you eat. For diabetics, it can bring your sugar levels down alongside insulin. But other side effects include making you feel fuller and delaying the emptying of your stomach so you’re not hungry for a longer time.
More than two in five American adults are considered obese. And, a 2023 report from the legislature's Joint Commission on Healthcare found 68% percent of Virginia's adults are overweight or obese. As states look to tackle the issue and the costly long-term health problems that come with it, they’re expanding access to GLP-1 drugs in the name of public health.
“The number of obese people in Virginia and the country — if you really want to move the needle in dealing with that, these drugs are one part of that equation,” Henrico Delegate Rodney Willett said at a recent press conference. The idea was linked to a broader swath of rural healthcare initiatives for the 2025 session.
Willett hopes to see Virginia reduce the body mass index, or BMI, required for those with federally funded Medicaid to access the drugs. Currently, a BMI of 40 is required for obese recipients and 27 for those with diabetes.
A BMI of 30 is considered obese. Obesity is linked to a laundry list of additional health problems, and those problems become costly for Virginia's $25 billion a year Medicaid program.
And GLP-1 isn't cheap — running up to $1,000 dollars a month.
Dr. Juan Pablo Arab specializes in liver and digestive issues at VCU Health. He said he understands pushback and sympathizes with the idea that we should be telling people to eat better and exercise more.
“That's true. But we’ve been trying to do that for the last 70 years in the medical field and we have not been very successful,” he said.
Arab thinks increased access could not only address short-term weight loss, but also long-term adjacent medical issues like hypertension that also increase healthcare costs.
“It’s difficult from a cost perspective, but more people benefit,” he said. “The more people we can get on to the medication, [the more] it's going to help reduce poor health outcomes.”
Rita Glaze-Rowe is an analyst with Real Chemistry. The pharmaceutical market research group released a report on how states cover the cost of GLP-1s with Medicaid. California spends just over $1.4 billion annually — the most of any state. Virginia comes in at number 22 with over $30 million in state spending to give low-income recipients access to the drug.
Glaze-Rowe said elected officials across the country are having the debate over GLP-1s’ high short-term cost versus its long-term benefits.
“Is this an investment in population health or is this going to continue to be a cost discussion?” she told Radio IQ.
Part of the problem is we don’t have research on long-term impacts yet, nor is the drug available at such a scale that those impacts could be seen yet.
“Intuitively, we know there’s going to be this shift in talking about cost versus the value generated… The question is when they’re going to see that benefit and what form it will take?” Glaze-Rowe said. “People will be healthier; they work [more], so we need to get to that value discussion.”
There’s also broader — and arguably much bigger questions — about making the drug available at scale.
Reporting from earlier in 2024 suggest the GLP-1-induced weight loss may led to a “baby boom,” as those who were either medically unable or physically struggling to produce a child are now able to.
“It just made me feel like a whole new person,” Catera Bentley, an Alabama resident on Mounjaro for five months, told CNN in May. “I was in a better mood every single day.”
But considering over 40 % of US adults are obese, the use of GLP-1 at scale could make dents in Americans’ consumption more broadly. What happens to food demand and the companies and people who produce that food if a third of the country eats significantly less?
“There’s plenty of times where the food industry has pivoted before,” Willett told Radio IQ. “It’s above my pay grade to say how it's going to work out, but this isn’t going to change overnight either. And we need healthier food,” he added. “The industry should be playing their part, too.”
Willett said there’s still specifics to work out, but he’s hoping to tackle the issue when legislators return to Richmond in January.
This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.
