Maine lawmaker wants MaineCare to cover Ozempic and other weight loss drugs
The proposal went before the Health and Human Services Committee for a public hearing on Tuesday.
Ozempic and other similar drugs such as Wegovy and Zepbound can help people lose weight by controlling appetite and reducing cravings.
But the drugs can be pricey, with 30-day prescriptions typically around $1,000 to $1,500. The cost is causing some private insurance to exclude them from coverage in their policies, although that practice has also resulted in lawsuits, including two in Maine.
Despite the cost, the drugs are popular, and according to a 2024 KFF poll, one in eight adult Americans have taken the Ozempic class of medications.
Ozempic and similar drugs were originally approved by the Food and Drug Administration as diabetes medicine, but they have also been found to help control weight. However, of the adults taking the drugs, about 40% are using the medications to treat diabetes, 22% were taking them primarily for weight loss, and the remaining for other reasons.
Anne Graham, D-North Yarmouth, a retired nurse practitioner, and the primary sponsor of the bill, L.D. 480, said MaineCare should cover the popular weight loss medications because patients should have access to all available tools to help them be healthier.
"Everyone should have access to obesity treatment, including these weight loss medications," Graham said.
Thirteen states — including New England states Massachusetts, Connecticut and Rhode Island — have approved the Ozempic class medications for their Medicaid programs. MaineCare is the state's name for Medicaid, which is a federal program operated by the states funded with a mix of federal and state dollars.
Dr. Allen Browne, of Falmouth, a retired pediatric surgeon, testified in favor of the bill, and said it is "wrong" to tell patients that a drug "exists, is safe and effective, but it's not available due to the cost."
Browne said some health care providers will not even mention the weight loss medications to their patients, knowing that it's too pricey for their patients to afford.
But Courtney Pladsen, MaineCare's medical director, testified against the bill, arguing that it would simply be too costly.
"Our conclusion is that the cost of adding this coverage would be prohibitive," said Pladsen, who pointed out that children in the MaineCare program can currently be prescribed Ozempic or similar drugs, but that the drugs are not available in MaineCare to adults.
Pladsen said that adding the medications would cost MaineCare $42 million in 2026 and $53 million in 2027.
"Requiring MaineCare to cover (these drugs) for treating obesity would have a significant fiscal impact. This is untenable given MaineCare's current budget shortfall," Pladsen said.
MaineCare is currently facing an $118 million shortfall in the current fiscal year. Under Gov. Janet Mills' budget proposal, a number of controversial cutbacks would be made to stabilize the MaineCare budget, including eliminating a cost-of-living increase for direct care workers and reductions of stipends for child care workers.
Mills' overall $11.6 billion biennium budget calls for some cutbacks, but also raises revenue with a cigarette tax increase from $1 to $3 per pack, and a 40% increase in the adult use cannabis sales tax, to 14%.
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