Phase 2 · GLP-1 ROI by comorbid segment · prototype

Where do GLP-1s actually pay off in a Medicaid book?

The cost offset concentrates in the comorbid segments. This sizes those segments and shows the net budget impact of treating each — so targeting beats blanket coverage.

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net Medicaid budget impact / yr (after offsets)

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members treated at the chosen uptake

Coverage gate: as of Jan 2026 only 13 state Medicaid programs cover GLP-1s for obesity (fee-for-service). If your state doesn't, this is a future budget question, not a current one. Under the Dec-2025 BALANCE model the negotiated Medicaid/Medicare price is $245/mo (~$2,940/yr) — the default below.

Inputs

Medicaid covered lives Adult share (%) Obesity rate in adults (%) GLP-1 uptake among eligible (%) Net drug cost / member / yr ($)

Net impact by comorbid segment

Offset = medical spending the drug avoids, as a share of drug cost. Edit any cell. Offsets are cumulative/long-run; short-term they're near zero (spend rises first).

Horizon

FPL basis

Obese segment	Share	Treated	Offset %	Net $/member	Total net / yr
Total

CVD-segment long-run offset (24%) is from the SELECT trial CEA (avoided diabetes 18.5% + CV events 3.8% + CKD 1.6%); other segments are literature-informed and editable.

How to read this — and the honest limits

The point isn't "GLP-1s pay for themselves" — they don't, on a Medicaid budget. Even at the BALANCE price with the best-segment 24% long-run offset, net cost per member stays well above zero. The point is where the cost is most justified: the diabetes and CVD segments (~27% of obese members) carry the real offset and clinical benefit, so a targeted policy is far cheaper per unit of value than blanket coverage — and the obese-only 39% is where short-term offset is ≈0.

Horizon is everything. The cited offsets are cumulative/lifetime; in the first 1–3 budget years offsets are near zero and spend often rises — use the Short-term toggle for the in-budget-window view.
Offsets are contested and population-specific. Defaults are literature- informed (CVD from SELECT); the real numbers for a plan need its own claims (the paid engagement).
Churn problem. If a member leaves the plan in 1–2 years, this plan pays the drug now while a future payer reaps the offset — a structural reason MCOs under-cover.
Segment shares are NHANES low-income obese adults (associational); persistence/adherence not modeled (real-world offsets erode as people stop the drug).

Sources: NHANES 2021–23 (segment shares), SELECT trial CEA (offset), KFF / CMS BALANCE (Medicaid price & coverage, Jan 2026). Calibrated estimate on public data — not a predictive model. Prototype; not for billing.