In Mississippi, Medicaid Coverage Of Weight Loss Drugs Fails To Catch On

April Hines has battled pinch her weight since she was a teenager.

But successful nan past mates of years, she's fallen from 600 pounds to 385, and her humor unit and humor sweetener levels are down, too. "I'm not arsenic fatigued arsenic I utilized to be, and I've been capable to spell backmost to church," she said.

Hines, 46, credits her weight nonaccomplishment to Trulicity, portion of a caller people of costly weight nonaccomplishment narcotics known arsenic GLP-1s, and her Medicaid sum for it. "It's a blessing," she said.

In a authorities wherever nan obesity complaint ranks among nan highest successful nan country, galore wellness providers were thrilled erstwhile Mississippi Medicaid successful 2023 began covering GLP-1s for group 12 and older. Only 13 states screen nan narcotics for Medicaid enrollees for obesity, and Mississippi's Medicaid programme typically has immoderate of nan sparsest benefits and strictest eligibility rules.

Hines is 1 of comparatively fewer enrollees to person utilized nan caller Medicaid benefit, which weight nonaccomplishment doctors successful nan authorities opportunity has been hindered by nationalist supplier shortages, nan state's anterior authorization process for nan drugs, and a deficiency of marketing. Just 2% of adults connected Mississippi Medicaid who meet nan weight-related criteria had been prescribed a GLP-1 arsenic of December 2024, according to a study to nan state's Medicaid Drug Utilization Review Board.

"It's a small sad to person truthful galore group retired location not benefiting," said William Rosenblatt, a family expert successful Columbus who treats Hines. "These narcotics get to nan guidelines origin of truthful galore wellness conditions."

Already-scarce Medicaid sum of nan highly touted weight nonaccomplishment narcotics could go much limited, pinch national Medicaid backing cuts expected successful nan aftermath of nan monolithic tax-and-spending measure President Donald Trump signed into rule successful July. The Congressional Budget Office estimated that nan rule would trim Medicaid spending by astir $911 cardinal complete a decade.

"The rule is going to create reasonably aggravated unit connected states not to grow benefits," said Michael Kolber, a partner successful nan wellness consulting patient Manatt. That whitethorn beryllium particularly existent for these drugs, which often costs astir $1,000 a period and could beryllium utilized by a ample percent of Medicaid recipients, he said.

GLP-1s, which person been utilized for years to dainty Type 2 diabetes, person gained wide attraction arsenic a measurement to suffer weight and trim obesity-related conditions and their semipermanent costs.

But states whitethorn stay reluctant to connection nan costly narcotics for obesity, because Medicaid recipients often churn connected and disconnected nan sum arsenic their income changes. And because nan drugs' wellness benefits whitethorn return years to materialize — specified arsenic averting a early bosom onslaught — nan semipermanent financial advantages could accrue to different insurers.

Even up of nan national cuts, which will mostly return effect successful 2027, states are already emotion nan pinch. North Carolina's Medicaid programme dropped its sum of nan narcotics this month, citing their precocious cost.

Coverage for nan weight nonaccomplishment narcotics presents a dilemma for nan Trump administration, which has identified arsenic priorities attacking chronic wellness conditions and reducing national spending. Health and Human Services Secretary Robert F. Kennedy Jr. has downplayed nan request for nan narcotics and said much accent should beryllium placed connected eating amended and exercising more.

In 2024, nan Biden management projected that Medicare and Medicaid screen weight nonaccomplishment narcotics to thief tackle obesity arsenic a nationalist wellness crisis. In April, nan Trump management revoked nan Biden-era proposal, saying nan programs would not screen GLP-1 narcotics for weight loss.

But successful August, The Washington Post reported nan Trump management was considering a five-year aviator programme for Medicare and Medicaid to screen nan narcotics aft all. No specifications person been released. Asked for remark connected nan report, Centers for Medicare & Medicaid Services spokesperson Alexx Pons told KFF Health News that each decisions spell done a cost-benefit review.

Meanwhile, nan Trump management has included nan GLP-1 narcotics Ozempic, Wegovy, and Rybelsus connected its database of 15 medicines that will beryllium taxable to value negotiations pinch pharmaceutical manufacturers nether its Medicare Part D program, a strategy created during nan Biden management amid guidance from Republicans. The results of those negotiations are expected to beryllium announced this fall.

Most backstage insurers don't screen GLP-1s for weight loss, which tin make nan narcotics unaffordable for those paying retired of pocket.

Further study provided to Mississippi's Medicaid supplier reappraisal committee shows that, successful nan first 15 months nan narcotics were covered, only astir 2,900 Medicaid enrollees property 12 aliases older started treatment. Nearly 90% of them were female, and galore had precocious humor unit and precocious cholesterol.

The study besides recovered astir enrollees utilizing nan narcotics lived successful nan southern, central, aliases bluish parts of Mississippi — not on nan Mississippi Delta connected nan occidental broadside of nan state, wherever obesity rates are highest, astatine astir 50%.

About 40% of adults successful Mississippi are obese, conscionable 1 percent constituent down top-ranked West Virginia, according to national data.

Mississippi Medicaid spokesperson Matt Westerfield told KFF Health News that nan authorities spent $12 cardinal successful nan first 15 months, providing nan weight nonaccomplishment narcotics to 2,200 big members. He said nan authorities approved nan caller narcotics connected nan logic that treating obesity would amended enrollees' wellness and yet could lead to costs savings by reducing diseases caused by obesity.

Westerfield said that while utilization has been beneath nan state's projections, specified curen decisions are up to patients and their doctors. He said nan authorities has been "raising awareness" of nan narcotics among wellness attraction providers, but he declined to remark further.

Rosenblatt, who useful for Baptist Medical Group, portion of a ample location wellness system, said immoderate doctors person little inducement to prescribe nan medicine, because nan authorities doesn't salary them to counsel patients astir basal dietary changes erstwhile taking nan caller drugs.

He called nan narcotics "game changers," adding that he has seen patients suffer 50 pounds aliases much wrong a fewer months of starting nan narcotics and nary longer request medications for glucosuria aliases different conditions.

A New England Journal of Medicine study published successful 2021 recovered participants receiving GLP-1 narcotics were much apt to show significant, sustained weight nonaccomplishment compared pinch those getting a placebo.

Other caller studies person shown nan narcotics thief group pinch obesity little their precocious humor unit and trim their likelihood of bosom attacks aliases strokes.

Mississippi is 1 of 10 states that person not expanded Medicaid eligibility nether nan 2010 Affordable Care Act to everyone pinch an income nether 138% of national poorness level, aliases $21,597 this year.

In Mississippi, Medicaid does not screen adults without limited children. Parents suffice only if their income is beneath 22% of nan national poorness level, aliases $5,863 for a family of 3 this year.

The state's anterior authorization process requires doctors to archive to nan authorities that patients meet definite obesity levels and that a curen scheme is successful place. Doctors must show that enrollees are losing weight each six months to renew their prescription.

At nan Hattiesburg Clinic — a large, multi-specialty group pinch a location successful Hattiesburg, Mississippi — Virginia Crawford, a expert who specializes successful obesity, said she was amazed truthful fewer patients are getting nan drugs. A twelvemonth ago, location were shortages of nan narcotics that could person curtailed physicians prescribing them. And she said nan state's anterior authorization requirements for nan supplier could discourage superior attraction doctors. Many communal medications do not require advancement reports aliases moreover anterior authorization.

"We request to make patients much alert that this action is disposable for them," she said.

Lauren Scott, 40, of Laurel, Mississippi, said that pinch nan thief of Medicaid coverage, she mislaid astir 100 pounds taking Wegovy.

"It's conscionable been amazing," she said of really nan supplier drastically trim her appetite. "I retrieve going to Outback pinch my husband, and we sewage nan bulb ringing appetizer and 16-ounce ribeye and crockery pinch other ranch dressing. I had immoderate bulb rings and started connected nan crockery and realized I could not eat immoderate much of this."