Minnesota mulls insurance mandate for weight-loss drugs

• More than 600,000 prescriptions for the medications were dispersed in Minnesota in 2024, a 13% increase from the prior year.

Yes, but: A high price tag and uneven insurance coverage prevent some patients who would benefit from a prescription from getting — or staying — on the medication, as Axios has reported.

• The annual cost of GLP-1s can be $11,000 or more without insurance.

How it works: The state bill would mandate coverage for the "management and treatment of obesity," including FDA-approved weight loss drugs, bariatric surgery and "evidence-based" behavioral and lifestyle interventions like nutrition counseling.

Friction point: Coverage mandates carry a high price tag because the federal Affordable Care Act dictates that states help cover private insurers' costs for mandates that go beyond what's required by federal law.

Case in point: A state Commerce Department analysis of an earlier version of the bill estimated that it could cost between $2.6 million and $8 million in the first year.

• Similar cost concerns have thwarted proposals to cover other popular but expensive medical treatments, including IVF.

What they're saying: Rep. Mike Howard (DFL-Richfield) told Axios that an increase in stories from constituents whose insurance companies decided to halt coverage of their GLP-1 treatment makes the push "more important than ever."

• "That is a huge blow for somebody to go from having it covered to potentially paying more than $1,000 a month," said Howard, who reintroduced the bill in the House this year. "People should be able to access the health care they need, at a price they can afford."

What we're hearing: The Minnesota Council of Health Plans doesn't take a position on individual mandates, but has said in the past that it worries about the cumulative impact these requirements have on overall plan and premium costs.

The other side: DFL Sen. Alice Mann, a doctor who's carrying the bill in the Senate, countered that the long-term savings — and quality of life benefits — are worth the upfront spend.

• "When we invest in prevention we can prevent all sorts of bad things from happening," Mann told Axios, citing increased risks of medical issues ranging from diabetes to falls.

The catch: State coverage mandates don't apply to the large swath of consumers who work for large companies that are self-insured, meaning not everyone would get the benefit even if it passed.

The big picture: The state debate comes as the Trump administration considers whether to follow through with a Biden proposal requiring Medicare and Medicaid to cover anti-obesity drugs.

• Sponsors of the state law said uncertainty about the fate of that rule — and the threat of Medicaid cuts more broadly — underscore the need for coverage in Minnesota.

What we're watching: Whether the state bills get a hearing this year.

Zoom out: More mandates in the mix

The weight loss coverage bill is one of a number of proposed insurance mandates competing for a slice of state funding in what's expected to be a relatively austere budget year.

• Other bills require coverage for vasectomies, maternal mental health, over-the-counter birth control, some acupuncture services and gene therapy for sickle cell anemia.

Plus: A proposed mandate for fertility treatment coverage has also been reintroduced.

State of play: Any of these bills would need bipartisan support to pass the divided Legislature.

• House Majority Leader Harry Niska (R-Ramsey) told Axios that while "a lot" of Republican legislators are concerned about the additional costs, his caucus will consider mandates on a case-by-case basis.

Gov. Tim Walz is open to a conversation about these mandates, but will wait until after Thursday's budget update to take a position on bills with a fiscal impact, spokesperson Claire Lancaster told Axios.