{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:26:36Z","timestamp":1794000396663,"version":"4.8.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Obesity poses a significant public health and economic challenge in the United States (U.S.), with rising prevalence, particularly among individuals enrolled in Medicaid\u2014the nation\u2019s public health insurance program for low-income populations. Anti-obesity medications (AOMs) have become integral to managing obesity, but trends in their utilization and spending within Medicaid remain underexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine Medicaid\u2019s utilization, reimbursement, and price trends for AOMs from 1999 to 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis assessing the utilization, reimbursement, and pricing of older and newer AOMs. Yearly prescription numbers and reimbursement were calculated for seven AOMs billed through Medicaid between 1999 and 2023. The average expenditure per prescription was used as an indicator of drug pricing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AOM prescriptions rose from 13,855 in 1999 to 938,663 in 2023, a 6,674% increase. Spending surged by over 77,805,466% due to the introduction of newer, more effective medications, including Wegovy and tirzepatide. The largest share of the market growth in 2023 was driven by these medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The significant increase in AOM utilization and spending highlights the growing burden of obesity on Medicaid, emphasizing the need for policy measures to manage rising costs and ensure equitable access to treatment.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1537181","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T05:39:27Z","timestamp":1752644367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Spending, utilization, and price trends for anti-obesity medications in U.S. Medicaid programs: an empirical analysis from 1999 to 2023"],"prefix":"10.3389","volume":"12","author":[{"given":"Abdulrahman A.","family":"Alsuhibani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan A.","family":"Alrasheed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim S.","family":"Alhomoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud","family":"Alsahali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyad S.","family":"Almalki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff Jianfei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e15770","DOI":"10.7759\/cureus.15770","article-title":"The burden of obesity in the rural adult population of america","volume":"13","author":"Okobi","year":"2021","journal-title":"Cureus"},{"key":"ref4","year":""},{"key":"ref5","doi-asserted-by":"publisher","first-page":"281","DOI":"10.15620\/cdc\/159281","article-title":"Obesity and severe obesity prevalence in adults: United States, august 2021\u2013august 2023","volume":"508","author":"Emmerich","year":"2024","journal-title":"Ctr Dis Control Prev"},{"key":"ref6","year":"2024"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1016\/j.soard.2017.08.002","article-title":"Obesity in America","volume":"13","author":"Rosenthal","year":"2017","journal-title":"Surg Obes Relat Dis"},{"key":"ref8","year":"2024"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1002\/oby.23725","article-title":"Estimated minimum prices and lowest available national prices for antiobesity medications: improving affordability and access to treatment","volume":"31","author":"Levi","year":"2023","journal-title":"Obesity"},{"key":"ref10","year":"2024"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e027780","DOI":"10.1136\/bmjopen-2018-027780","article-title":"Estimation of cost-based prices for injectable medicines in the WHO essential medicines list","volume":"9","author":"Gotham","year":"2019","journal-title":"BMJ Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1038\/s41574-019-0176-8","article-title":"Obesity: global epidemiology and pathogenesis","volume":"15","author":"Bl\u00fcher","year":"2019","journal-title":"Nat Rev Endocrinol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100070","DOI":"10.1016\/j.obpill.2023.100070","article-title":"Comprehensive care for patients with obesity: an obesity medicine association position statement","volume":"7","author":"Fitch","year":"2023","journal-title":"Obesity Pillars"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1056\/NEJMoa1105816","article-title":"Long-term persistence of hormonal adaptations to weight loss","volume":"365","author":"Sumithran","year":"2011","journal-title":"N Engl J Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4607","DOI":"10.1002\/phar.4607","article-title":"Incretin hormone agonists: current and emerging pharmacotherapy for obesity management","volume":"3","author":"Alhomoud","year":"2024","journal-title":"Pharmacotherapy"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4158\/EP161365.GL","article-title":"American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity","volume":"22","author":"Garvey","year":"2016","journal-title":"Endocr Pract"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"S102","DOI":"10.1161\/01.cir.0000437739.71477.ee","article-title":"2013 AHA\/ACC\/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines and the Obesity Society","volume":"129","author":"Jensen","year":"2014","journal-title":"Circulation"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1210\/jc.2014-3415","article-title":"Pharmacological management of obesity: an endocrine society clinical practice guideline","volume":"100","author":"Apovian","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.amjmed.2008.09.041","article-title":"Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis","volume":"122","author":"Buchwald","year":"2009","journal-title":"Am J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e317","DOI":"10.1097\/AS9.0000000000000317","article-title":"Metabolic and bariatric surgery utilization trends in the United States: evidence from 2012 to 2021 national electronic medical records network","volume":"4","author":"Alsuhibani","year":"2023","journal-title":"Ann Surg Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1001\/jama.292.14.1724","article-title":"Bariatric surgery: a systematic review and meta-analysis","volume":"292","author":"Buchwald","year":"2004","journal-title":"JAMA"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1741-7015-11-8","article-title":"Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes","volume":"11","author":"Neff","year":"2013","journal-title":"BMC Med"},{"key":"ref23","year":"2023"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/s40265-024-02029-0","article-title":"Pharmacotherapy as an augmentation to bariatric surgery for obesity","volume":"84","author":"Horv\u00e1th","year":"2024","journal-title":"Drugs"},{"key":"ref25","year":"2024"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1001\/jama.2021.3224","article-title":"Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial","volume":"325","author":"Rubino","year":"2021","journal-title":"JAMA"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"435","DOI":"10.3390\/ijerph14040435","article-title":"Economic burden of obesity: a systematic literature review","volume":"14","author":"Tremmel","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"ref28","volume-title":"The heavy burden of obesity: the economics of prevention","year":"2019"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e0247307","DOI":"10.1371\/journal.pone.0247307","article-title":"Association of body mass index with health care expenditures in the United States by age and sex","volume":"16","author":"Ward","year":"2021","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09581596.2024.2333407","article-title":"The economic burden of obesity in 2024: a cost analysis using the value of a statistical life","volume":"34","author":"Sweis","year":"2024","journal-title":"Crit Public Health"},{"key":"ref31","year":"2024"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e2336400","DOI":"10.1001\/jamanetworkopen.2023.36400","article-title":"Cost-effectiveness of Antiobesity drugs for adolescents with severe obesity","volume":"6","author":"Mital","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1016\/S0140-6736(24)01356-4","article-title":"International coverage of GLP-1 receptor agonists: a review and ethical analysis of discordant approaches","volume":"404","author":"Dellgren","year":"2024","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1001\/jama.2024.3073","article-title":"State coverage and reimbursement of antiobesity medications in medicaid","volume":"331","author":"Liu","year":"2024","journal-title":"JAMA"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s40273-014-0230-2","article-title":"Savings in Medical Expenditures Associated with reductions in body mass index among US adults with obesity, by diabetes status","volume":"33","author":"Cawley","year":"2015","journal-title":"PharmacoEconomics"},{"key":"ref36","author":"Seervai","year":"2019"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.1002\/oby.21533","article-title":"Low adoption of weight loss medications: a comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s","volume":"24","author":"Thomas","year":"2016","journal-title":"Obesity"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1001\/jamaoncol.2021.4323","article-title":"Understanding the implications of medicaid expansion for cancer care in the US: a review","volume":"8","author":"Ermer","year":"2022","journal-title":"JAMA Oncol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.gtc.2023.02.003","article-title":"Disparities in access and quality of obesity care","volume":"52","author":"Washington","year":"2023","journal-title":"Gastroenterol Clin N Am"},{"key":"ref40","year":"2024"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1186\/1472-6963-12-327","article-title":"Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005","volume":"12","author":"Patrick","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"ref42","year":"2024"},{"key":"ref43","year":"2024"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1007\/s11096-021-01330-2","article-title":"Descriptive analysis of reported adverse events associated with anti-obesity medications using FDA adverse event reporting system (FAERS) databases 2013-2020","volume":"44","author":"Alsuhibani","year":"2022","journal-title":"Int J Clin Pharm"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e072686","DOI":"10.1136\/bmj-2022-072686","article-title":"Effectiveness and safety of drugs for obesity","volume":"384","author":"Henderson","year":"2024","journal-title":"BMJ"},{"key":"ref46","year":"2024"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1002\/jmv.26237","article-title":"Obesity aggravates COVID-19: a systematic review and meta-analysis","volume":"93","author":"Yang","year":"2021","journal-title":"J Med Virol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e13095","DOI":"10.1111\/obr.13095","article-title":"Obesity is a risk factor for developing critical condition in COVID-19 patients: a systematic review and meta-analysis","volume":"21","author":"F\u00f6ldi","year":"2020","journal-title":"Obes Rev"},{"key":"ref49","year":"2024"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.japh.2023.10.002","article-title":"Trends in glucagon-like peptide 1 receptor agonist use, 2014 to 2022","volume":"64","author":"Watanabe","year":"2003","journal-title":"J Am Pharm Assoc"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e21016","DOI":"10.1097\/MD.0000000000021016","article-title":"The association of obesity with health insurance coverage and demographic characteristics: a statewide cross-sectional study","volume":"99","author":"Mylona","year":"2020","journal-title":"Medicine"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1537181\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T05:39:27Z","timestamp":1752644367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1537181\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":51,"alternative-id":["10.3389\/fmed.2025.1537181"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1537181","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]},"article-number":"1537181"}}