Rep. Arvind Venkat, D-Pittsburgh, and Rep. Bryan Cutler, R-Quarryville, would create a subscription model for those who use GLP-1 medication. The lawmakers’ proposal comes at a time when state health officials are advocating to limit the number of state residents using GLP-1 medications because of the cost.

Pennsylvania’s Medicaid coverage of the drugs is expected to cost $1.3 billion in 2025 — up from a fraction of that several years ago — and is contributing to projections of a multibillion-dollar budget deficit, according to an April story by the Associated Press. The state is thinking about requiring Medicaid patients who want to use GLP-1s for weight loss to meet a certain number on the body-mass index or try diet and exercise programs or less expensive medications first.

“It is a medication that’s gotten a lot of hype and a lot of press, and has become very popular in its use and it is wildly expensive,” Dr. Val Arkoosh, Pennsylvania’s human services secretary, told a state House hearing in March.

Venkat and Cutler propose a different solution to the same problem. They want Pennsylvania to consider a model used by Louisiana and Washington for subscription models, sometimes called the “Netflix model,” for medications used to treat Hepatitis C. Under this payment model, the state agrees to pay a certain amount per treatment up to a cap, at which point additional treatments are provided at no cost to the state.

Rep. Arvind Venkat, D-Pittsburgh, speaks during a news conference earlier this year.

“Among other benefits, this approach allows the state flexibility to find a good price based on bulk purchasing and ensures certainty in this area of pharmaceutical costs,” Venkat and Cutler wrote in their co-sponsorship memorandum. “Pharmaceutical companies have also been willing to participate in such agreements due to the large-scale purchase of medications. It is estimated in Louisiana that their cost per year for Hepatitis C medications using this model has decreased from a potential high of $760 million/year to $35 million/year in their Medicaid program.”

The state would need to receive a waiver from the Centers for Medicare and Medicaid Services to allow the state to enter into a subscription model for GLP-1 medications.

“Our legislation will drastically reduce spending on these drugs without limiting the number of people who can receive necessary treatment for obesity,” Venkat and Cutler wrote.

At least 14 states already cover the cost of GLP-1 medications for obesity treatment for patients on Medicaid, the federal health care program for people with low incomes. Democrats and Republicans in at least a half-dozen other states floated bills this year to require the same coverage, according to an Associated Press analysis using the bill-tracking software Plural. Some bills have stalled while others remain alive, including a proposal in Arkansas requiring GLP-1s to be covered under Medicaid when prescribed specifically for weight loss. Iowa lawmakers are thinking about ordering a cost-benefit analysis before making the commitment. Already, West Virginia and North Carolina ended programs in 2024 that provided coverage for state employees, citing cost concerns.

Overall Medicaid spending on GLP-1 drugs — before partial rebates from drug manufacturers — jumped from $577.3 million in 2019 to $3.9 billion in 2023, according to a November report from KFF, a nonprofit that researches health care issues. The number of prescriptions for the drugs increased by more than 400% during that same time period. The average annual cost per patient for a GLP-1 drug is $12,000, according to a Peterson-KFF tracker.

States that do provide coverage have tried to manage costs by putting prescribing limits on the GLP-1s. There’s also some evidence that if Medicaid patients lose weight with the drugs, they’ll be healthier and less expensive to cover, said Tracy Zvenyach of Obesity Action, an advocacy group that urges states to provide coverage, in an Associated Press report. About 40% of adults in the U.S. have obesity, according to the U.S. Centers for Disease Control and Prevention. Obesity can cause hypertension, Type 2 diabetes and high cholesterol, which lead to greater risks of things like stroke and heart attacks.