Legislative committee finds Medicaid rule on GLP‑1 drugs deficient, citing cost and oversight concerns

Commissioner Lisa Lee of the Department for Medicaid Services told the committee the regulation (907 KAR 023010) was amended to remove language that prevented coverage of GLP‑1 medications tied to weight loss and to create a pathway for coverage when there is an underlying medical condition such as diabetes or heart disease. "Coverage of these medications are gonna be—they're gonna have guardrails around it," Lee said, describing prior authorization and step‑therapy safeguards.

Lawmakers pressed the department on costs and eligibility. Jonathan Scott, the department's chief legislative and regulatory officer, said the fiscal analysis drew on current program expenditures and utilization, noting "we have a little over 20,000 individuals in the Medicaid program on these medications" out of about "1,400,000 individuals in the program." Scott said the agency's data‑analytics office modeled anticipated utilization and step therapies to estimate net fiscal impact.

Several committee members said they were sympathetic to the health benefits described but worried implementation timing and potential rapid growth in utilization would strain the Medicaid budget. Co chair Lewis and others asked that the proposal be reviewed by the Medicaid Oversight and Advisory Board (MOAB) so lawmakers and stakeholders could see more complete outcome and cost data before the change takes effect.

Chair West moved to find the regulation deficient to allow legislative review during the budget session; after members explained their votes, the motion passed with five ayes and one no. Representative Marzion told the committee MOAB has scheduled the issue for its late‑February meeting to provide the broader policy and fiscal context lawmakers requested.

Next steps: The regulation will be treated as deficient, giving the Legislature time to review potential budget impacts and for MOAB to gather outcome and cost data before the agency moves forward with implementation.