MONTGOMERY, Ala. — A joint task force charged with researching and proposing solutions for Alabama’s high obesity and diabetes rates appeared this week to pour cold water on the idea of expanding access to weight-loss drugs, something the body had explored for more than a year.
Started and chaired by Rep. Ed Oliver, D-Dadeville, the task force met for its final meeting of the year at the Alabama State House, and was picking up on earlier discussions related to expanding access to the GLP-1 class of weight-loss drugs, which include drugs like Ozempic and Wegovy. With Alabama’s obesity rate at around 38%, it is the seventh-most obese state in the nation.
“This is probably as important as any issue that we deal with in government in terms of money and health,” Oliver said.
“I will tell you that there are some things we have control over, and some things we don’t, but it’s a lot of fun to watch the private sector try to work these things out, the balance between what insurance companies can afford, (and) what can drug manufacturers do in terms of making weight loss drugs affordable.”
Presenting during the meeting was William Ashmore, chief executive officer of the Alabama State Employees’ Insurance Board, or SEIB, the state health care program for state employees.
Ashmore said of SEIB’s just over 100,000 members, roughly 55% were considered obese, and nearly 84% overweight, higher rates when compared to Alabama’s general population due to SEIB members generally being older and working desk jobs, Ashmore said.
“If we can reduce the number of people that are high risk, it’s going to be more economical for the state,” Ashmore said. “We know that the cost of obesity contributes to about 17% of our total costs.”
Ashmore shared data showing the clinical impact as members’ weight increased to unhealthy levels, including higher rates of diabetes. Those with body mass indexes of 40 or above more than six-times as likely to have diabetes.
The data showed similar trends with other medical conditions that often incur higher costs to the state, such as hypertension, which SEIB members were two-and-a-half times more likely to have with a BMI of between 30 and 34 compared to a healthy BMI, or more than three-and-a-half times more likely with a BMI of 40 or above.
Congestive heart failure and low back disorder rates showed similar increases that correlated with increased BMI, enough so that dropping from a BMI of 27 to 20 could produce significant cost savings to the state, Ashmore explained.
“If you compare it to the baseline, you take an overweight person with a BMI of 25 to 29, that category would cost $239 more (per year),” Ashmore said. 
Alabama has the seventh-highest obesity rate in the nation, according to CDC data.While the main drivers of obesity in Alabama and the United States are multifaceted, including increased sedentary lifestyles and consumption of calorie-dense and nutrient-poor foods, one solution that the task force has discussed at length has been expanding access to GLP-1 drugs.
The issue, Ashmore explained, came down to costs, which in the United States are uniquely expensive. Ozempic, for instance, typically costs around $936 a month in the United States, but in countries like Germany, Sweden, Australia and France, the same drug costs $103, $96, $87 and $83, respectively.
“The point I want to make here is in the United States, the GLP-1 (drugs) are just so much more expensive than everywhere else, and you can look at some of the other countries where you can actually get Ozempic for less than $100,” he said.
Currently, the SEIB covers GLP-1 drugs for members with diabetes, but not for those without the disease as a weight-loss tool. Its extremely high cost in the United States when compared with the rest of the world, which is largely due the United States’ lack of drug prices regulations, would make expanding their accessibility not feasible, Ashmore said.
“Back in 2018, the GLP-1 drugs, we spent $3.5 million; this past year, we spent $35.5 million,” he said. “Went up ten times, so that’s a very significant expenditure in our budget. This one category of drugs by itself represents 7% of our total spend, and that’s only covering it for the diabetics, and not for weight loss.”
State funding for the SEIB has also largely remained static over the past 14 years, with state lawmakers allocating $371.5 million to the program in the 2024 fiscal year budget, a 2.7% increase when compared to 2010.
Task force member Richard Embrey, a thoracic surgeon at Princeton Baptist Medical Center, endorsed whole-heartedly the effectiveness of GLP-1 drugs, but told Alabama Daily News it wasn’t fiscally feasible to expand their access given their high costs.
“It’s certainly very effective at weight loss, no question about it, but at what cost, and the cost of obesity is a fraction of the cost of the drugs, so it’s hard to make right now a business case for covering these drugs for obesity,” Embrey told ADN. “It’s very different for diabetes because the cost of caring for patients with diabetes is so much higher than simply obesity, so that’s part of it to crack.”
While a recent $35 billion proposal from the Joe Biden administration for Medicare and Medicaid to cover GLP-1 drugs could dramatically lower the drugs’ costs and expand access, President elect-Donald Trump’s cabinet pick of Robert Kennedy Jr. for the role of secretary of health and human services, which includes the Centers for Medicare & Medicaid Services, could pose another challenge, task members feared.
“As many of you are aware, we’ve got RFK, looks like he’s going to be our health guru, he hates weight loss drugs,” Oliver said. “He thinks everybody ought to be out doing pushups and eating chicken, and I can’t say that he’s wrong.”