By Dan Levine and Chad Terhune
(Reuters) -Novo Nordisk, which lobbied to win Medicaid reimbursement for its obesity drug Wegovy, is fighting to keep that coverage as some U.S. states struggle with the treatment's costs, according to state documents, company emails and interviews with lawmakers and advocates.
Novo's lobbying efforts helped to convince 14 U.S. states to cover Wegovy for low-income patients under their Medicaid health insurance programs. The Danish drugmaker argued that governments would
save money on healthcare as more Americans lose weight and reduce their risk of diabetes, heart disease and other conditions.
Instead, several states found their spending surged due to Wegovy's cost and widespread demand. California, North Carolina, Pennsylvania and Connecticut have said they'll cut weight-loss drug coverage or seek to scale it back.
"There are almost 4 in 10 adults in Medicaid with obesity so any changes in access to these drugs could potentially result in sizable financial impacts," said Liz Williams, a senior policy manager at nonprofit KFF's Program on Medicaid and the Uninsured.
Medicaid and other public-funded programs account for most U.S. coverage of weight-loss drugs. Any pullback poses risks for Novo, which has lost its lead in the obesity market to rival Eli Lilly, ousted its chief executive and cut sales projections due to lower U.S. growth. It also means that fewer Americans will have access to highly effective weight-loss treatments.
In response, Novo has mobilized a wide array of community groups and health professionals to argue on its behalf, Reuters reporting showed.
"Novo Nordisk has publicly and openly advocated for our health care system to understand that obesity is a serious, chronic, treatable disease," the company said in a statement to Reuters, when asked about its work with advocates.
"Patients deserve affordable access to the full continuum of care, including coverage by their insurance plans."
MAKING A CASE IN CALIFORNIA
The community groups include the Alliance for Women's Health and Prevention, which has worked closely with Novo to protect Medicaid and other public insurance coverage, the Washington-based nonprofit told Reuters.
When California Gov. Gavin Newsom proposed this year cutting weight-loss coverage, Millicent Gorham, chief executive of the Alliance for Women's Health and Prevention, urged him and state lawmakers to reconsider. California Medicaid was one of the first to cover Wegovy, spending nearly $1 billion before rebates on more than 720,000 prescriptions from 2022 through the end of 2024, according to a Reuters tally of federal data.
"California is going to pay either way - either by paying to treat the chronic disease now or by paying for the consequences later," Gorham wrote in letters to Newsom and state lawmakers in May, posted on the Alliance's website.
Damon Davis, an associate director in public affairs for Novo, emailed other advocacy groups a week later and included Gorham's letter as an example to follow, according to documents reviewed by Reuters. "The urgent need for Medicaid advocacy to continue obesity management medication coverage in California continues," Davis wrote in his email.
Reuters was unable to determine which advocacy groups received the email. Davis didn't respond to requests for comment.
Gorham is not giving up hope of reversing California's decision to end weight-loss drug coverage in January 2026. "We are all working together to get this across the line," she said in an interview. "We're going to keep fighting."
Novo and Lilly are listed online as members of the Alliance's corporate roundtable. Gorham declined to say how much the drugmakers have donated and told Reuters she lobbied state officials on her own volition. The companies didn't respond to questions about their donations.
AN OBESITY SOCIETY FOUNDED BY NOVO STAFF
In some cases, Novo's ties to supporters are less visible. The North Carolina Obesity Society is a leading opponent of ending Medicaid weight-loss coverage in the state. The organization was incorporated by two Novo employees last year, state documents show, though its website doesn't mention their role.
The two Novo employees, Natalie Bovino and Carrie Royer, worked as health educators for the company. They told Reuters they formed the group in their spare time.
"This was our passion project," Bovino said. "It's really sad for these people on Medicaid to lose coverage. It makes me sick."
Bovino and Royer said their supervisors at Novo told them they couldn't hold any official role in the organization or serve on the board, both potential conflicts of interest.
The obesity society "was in no way affiliated or in partnership with Novo Nordisk," Royer said. "Sometimes someone just has to have the idea."
Emily Weaver, a nurse practitioner and a board member of the society, said the group acts independently and does not "bolster or build up any one drug or any company." She told Reuters that Novo is a gold-level donor, contributing at least $10,000. Lilly is a platinum donor, which starts at $15,000.
In a statement to Reuters, Novo said it openly engages in "advocacy, lobbying, and working with others" to support access to weight-loss drugs. "Our business practices fully comply with applicable law and reflect our unwavering commitment to ethical business conduct."
Novo didn't respond to questions about state-specific lobbying and coverage decisions.
Lilly said it is working with Medicaid programs on access to obesity medications and also supports nonprofit organizations in their advocacy for more widespread obesity care.
Expectations regarding company lobbying can differ by country. In Britain, a pharma industry group reprimanded Novo for failing to disclose funding for weight-management courses that promoted its older drug, Saxenda. U.S. laws require that lobbyists disclose their work for specific companies and that drugmakers make public any payments to medical professionals for consulting, speeches, travel and meals.
However, pharma companies are not required to spell out their funding for U.S. advocacy groups that promote their medicines, obscuring the influence they may wield on policy decisions, said Alan Sager, a health policy professor at Boston University.
"They're thinking about their financial well-being, not our medical well-being nor our ability to afford healthcare,” Sager said.
MAKE IT AFFORDABLE, CRITICS SAY
With nearly 100 million Americans living with obesity, Novo and Lilly could still benefit even by charging far less for their treatments, which carry a monthly list price above $1,000, their critics say. That would allow more governments and private health plans to cover it.
U.S Senator Bernie Sanders has accused Novo of "price gouging," citing a Yale University study that estimates the new weight-loss drugs could still yield a profit if sold for about $5 per month.
"As important as these drugs are, they will not do any good for the millions of patients who cannot afford them," Sanders wrote in a July 2024 opinion piece. President Donald Trump has since vowed to lower the price of Novo's weight-loss drug in negotiations with the federal government.
Novo said the Yale study was "misleading and an oversimplification" about the costs of launching a new medication. U.S. patients with insurance often pay $25 or less for a month's supply of Wegovy, while those without coverage can pay $499 out of pocket, Novo said.
Soon fewer patients will be able to use the drugs. California's budget, passed in June, rescinds all Medicaid coverage for these GLP-1 weight-loss treatments to save an estimated $85 million in the coming year and nearly $700 million by 2029.
North Carolina officials cut Medicaid coverage for GLP-1 weight-loss drugs effective Oct. 1. One legislative estimate said the move could save up to $30 million over the next two years. And Connecticut officials are restricting their use to people with another health condition in addition to obesity, aiming to save about $45 million over the next two fiscal years.
Meanwhile, Pennsylvania is considering limiting their use to patients with more severe obesity after spending $650 million on GLP-1 drugs last year for diabetes and weight loss. That amount is projected by state officials to double this year.
Novo is bracing for further cuts under Trump's plan to slash $1 trillion from Medicaid over 10 years. Davis, the Novo official, emailed advocacy groups in July seeking "significant activation" to oppose cuts to state employee coverage for weight-loss drugs in Massachusetts, according to documents reviewed by Reuters.
The issue, Davis wrote, "may also arise in additional states as they try to make up funds that will be lost."
CHRIS CHRISTIE MAKES AN APPEARANCE
Novo's lobbying to state Medicaid plans began soon after U.S. regulators approved Wegovy in 2021. Among its first moves, the company hired Chris Christie, former New Jersey governor and Republican presidential candidate, according to a lawsuit by a former in-house Novo lobbyist.
Christie urged advisors to Arizona's Republican governor at the time to consider covering the drug for 34,000 state employees in a phone conversation that year, the lawsuit said.
"He was animated as to its value and saw this as a huge step in improving healthcare in a larger way," one of those advisors, Andy Tobin, said in an interview. Ultimately, Tobin said Novo did not have enough data about potential savings to justify the expense. Arizona did not extend coverage.
Christie did not publicly report being hired by Novo to influence officials in Arizona. Karl Rickett, a spokesman for Christie, said the former governor's firm "provided Novo Nordisk with strategic advisory services that did not require registration" with state ethics officials.
Novo had better luck in other states. Christy Davis, a Mississippi nurse practitioner who treats people with obesity, pleaded with lawmakers there in December 2022. All patients, including those on Medicaid, deserve access to proven treatments for obesity, including medications, counseling and surgery, she said.
"The cost of obesity is killing us as a state financially and literally," Davis told legislators.
Davis did not tell lawmakers that she received nearly $50,000 from Novo that same year in speaking fees and travel expenses to promote the company's obesity drugs. She said that the omission was her mistake in an interview with Reuters.
Members of the state Senate panel didn't respond to requests for comment. Davis did mention her role as a Novo-paid speaker at a subsequent legislative hearing in 2023.
Mississippi, which has one of the highest rates of obesity in the country, has made Wegovy available to Medicaid recipients since July 2023. As of December 2024, only 3,299 adult Medicaid beneficiaries had started on a GLP-1 weight-loss drug, according to a recent state report.
(Reporting by Chad Terhune and Dan Levine; Editing by Michele Gershberg and Daniel Flynn)
