Health plan restricts GLP-1 medications to diabetes treatment only

In a recent government meeting held on April 29, 2025, Mohave County officials discussed critical updates regarding the county's health plan, particularly focusing on the coverage of certain medications and their implications for residents. The meeting highlighted the ongoing challenges surrounding the use of GLP-1 medications, which are primarily prescribed for type 2 diabetes but have gained popularity for weight loss.

One of the key points of discussion was the restriction on prescribing medications like Manjaro and Ozempic for weight loss purposes. Officials clarified that these drugs are only covered under the health plan for members diagnosed with type 2 diabetes. This restriction aims to prevent misuse of the medications, ensuring that they are prescribed only to those who genuinely need them for diabetes management. The conversation underscored the importance of maintaining the integrity of the health plan while addressing the rising demand for weight loss treatments.

The meeting also touched on the financial aspects of these medications. While the retail price for prescriptions like Manjaro and Ozempic can exceed $1,000, rebates significantly reduce the actual cost to the health plan. For instance, the effective cost after rebates can drop to around $600 to $700 for Manjaro and $400 to $500 for Ozempic. This highlights the complex nature of pharmaceutical pricing and the role of rebates in managing healthcare costs.

Additionally, the discussion included insights into specialty medications, particularly Trikafta, which is used for cystic fibrosis. Trikafta accounted for a notable percentage of the overall plan expenditure, emphasizing the financial burden that specialty drugs can impose on health plans. The officials noted that the plan's spending on chronic inflammatory diseases, such as psoriasis, was also significantly impacted by rebates and manufacturer assistance programs, which collectively saved the plan approximately $350,000.

Looking ahead, the meeting addressed the potential for expanding access to GLP-1 medications through manufacturer coupons, which could provide additional savings for members. The officials are currently in discussions with Gallagher, the trust's consultant, to explore this option further.

In conclusion, the meeting underscored the ongoing efforts of Mohave County officials to balance the needs of residents with the financial sustainability of the health plan. As discussions continue regarding medication coverage and cost management strategies, the county remains committed to ensuring that essential medications are accessible to those who need them while navigating the complexities of pharmaceutical pricing.