Two-thirds of people who benefit from a government-run insurance program for low-income people in Pakistan are obese or overweight, but that doesn’t mean they have access to new weight-loss drugs. Easy access is available.
According to a fall 2023 report by KFF, a research organization, only 16 states have added glucagon- peptide (GLP-1) receptor agonists, a new class of injectable drugs, to their drug lists. The type is used for both diabetes and weight loss. The report focused on prescriptions for Ozampic, Rybalsas, Vigovi and Monjaro (the latter also a GIP receptor antagonist). Of these drugs, Vigovi is the only one officially approved for weight loss, all others are diabetes drugs used unproven to aid in weight loss.
The report states that “from generally available Medicaid data, it is not yet possible to estimate how much of the increased use of these drugs is related to the treatment of diabetes and how much to obesity, or A combination of both.”
Although Medicaid is required by law to cover any drug approved by the Food and Drug Administration (FDA), coverage for weight loss, cosmetic needs (such as wrinkles) and cough and cold medications is limited. There is an exception for
“State Medicaid programs may cover these injectable drugs, but they don’t have to,” Liz Williams, a senior policy analyst for KFF’s Program on Medicaid and the Insured, told Very well. “
Importantly, it is more lenient than the Medicare coverage rules, which prohibit coverage of obesity or weight loss medications altogether. The hope is that more states will add Medicaid coverage for anti-obesity drugs during budget negotiations during the current state legislative session, Kate McEvoy, executive director of the National Association of Medicaid Directors, told Very well.
Each state’s Medicaid website has a formulary (drug list) where you can check if GLP-1 drugs – or other weight-loss drugs – are specifically prescribed for obesity, overweight and/or Weight loss tips are covered.
The states that provide coverage may also have specific rules.
Even in states with coverage for obesity medications, Medicaid beneficiaries may face barriers to obtaining prescriptions. Under current Medicaid rules in Virginia, for example, patients who want to get GLP-1 drugs for chronic weight control must get a letter from their doctor, according to a report by Milliman, an insurance company. In which it is written that their weight is dangerous for disability and life. They need to have used a drug from a different class of drug within the past six months and not have benefited from it before receiving approval to use GLP-1.
In Michigan, approval of Medicaid is contingent upon a physician’s letter specifying that the medication is part of a comprehensive weight loss treatment plan, including diet and exercise.
When it comes to reauthorization for someone already using a GLP-1 drug for weight control, Mississippi, Virginia, and Michigan each require proof that weight has been maintained. or improved to show that the drug is working.
These barriers exist because state Medicaid budgets cannot afford to cover all those who could benefit from the drug. While some private insurance companies charge higher copays to help cover drug costs, the maximum copay under Medicaid is $8, except for drugs on the Preferred Drug List. I am not included. That’s what Wayne Turner, a senior attorney at the National Health Law Program in Washington, D.C., told Veriwell.
How to Continue Using Mounjaro or Ozempic When You Can’t Buy Them:
Although it may take some time for all state Medicaid programs to cover drugs specifically for weight loss, if GLP-1 is approved for another reason in the meantime, Medicaid in each state will It would have to be covered for this use, and weight reduction could be a side benefit. That’s what happened recently with Vigovi, which won FDA approval in March to reduce the risk of heart attack, stroke and other heart diseases in obese or overweight adults with heart disease. . Earlier, it was only prescribed for weight loss. The companies that make GLP-1 are researching it for other uses, including treating insomnia and addiction.
