Trump will not force Medicaid to cover GLP-1 for obesity. A few states do it anyway.

Trump will not force Medicaid to cover GLP-1 for obesity. A few states do it anyway.

When Page Campbell's doctor recommended that she try an injectable prescription drug called Wegovy to lose weight before scheduling bariatric surgery, she readily agreed.

“I've struggled with my weight for so long,” said Campbell, 40, a single mother of two. “I’m not against trying something.”

In early April, about four weeks after she started taking Wegovy, Campbell said she did not experience any side effects such as nausea or intestinal irritation. But she doesn't use a scale at home, she said, so she doesn't know if she's lost weight since her last doctor's appointment earlier this year, when she weighed 314 pounds. Still, she was confident about achieving weight loss.

"It's going to work because I'm putting in the work. I'm changing my eating habits. I'm working out," said Campbell, a shipping manager at a store in Michaels. “I will not preserve myself on the second foundations.”

Wegovy belongs to an expensive class of drugs called GLP-1 (short for glucagon-like peptide-1 agonists) that has taken up the treatment of obesity in recent years, offering patients who have tried to lose weight in countless other ways and failed to lose weight.

Campbell gained access to Wegovy via South Carolina Medicaid's decision to cover these weight loss medications in late 2024. But the drugs remain out of reach of millions of patients across the country who could benefit from them because many public and private health insurers have deemed the drugs too expensive.

A report published in November by KFF, a nonprofit health information organization that includes KFF Health News, found that only 13 states covered GLP-1 for obesity treatment for Medicaid beneficiaries as of August. South Carolina became November 14th.

Liz Williams, one of the report's authors and a senior insurance executive for the Medicaid and uninsured program at KFF, said she was not aware of any other state Medicaid programs joining the list since then. Looking forward, remaining states may be unwilling to add a new, expensive drug benefit while bracing for potential federal cuts from Congress, she said.

“As the state budget debate evolves, it may impact how states think about it,” Williams said.

The federal government won't be helping any time soon either. Medicare covers GLP-1s to treat diabetes and some other health conditions, including obstructive sleep apnea and cardiovascular disease, but not obesity. In early April, the Trump administration announced it would not finalize a rule proposed by the Biden administration that would have restricted weight loss benefits to an estimated 7.4 million people covered by Medicare and Medicaid. In the meantime, the FDA is poised to force less expensive, compounded versions of these drugs off the market.

And the barrier to entry remains high even for Medicaid patients in the few states that have agreed to cover the drugs without a federal mandate.

Case in point: In South Carolina, where more than a third of all adults and nearly half of the African-American population qualify as obese, the state Medicaid agency estimates only 1,300 beneficiaries who meet strict requirements for GLP-1 coverage.

Under one of those requirements, Medicaid beneficiaries who have access to these drugs to lose weight must engage in "increased exercise activity," said Jeff Lieritz, spokesman for the South Carolina Department of Health and Human Services.

Campbell, who has Medicaid coverage, was granted coverage for Wegovy based on her body mass index. First, however, she had to submit six months' worth of documentation to prove that she had tried to lose weight after receiving nutritional advice and following a 1,200-calorie diet, said Kenneth Mitchell, one of Campbell's doctors and the medical director of bariatric surgery and object medicine at Roper St. Francis Health Medicine.

Campbell's wegovy prescription was approved for six months, Mitchell said. When that authorization expires, Campbell and her health care team will have to submit more documentation, including evidence that she has lost at least 5% of her body weight and has been keeping up with nutritional counseling.

“It's not just 'Send in a prescription and they'll cover it.' It's pretty tedious," Mitchell said. "Not many people will do that."

Mitchell said South Carolina Medicaid's decision to cover these drugs stemmed from excitement among those who worked in his medical specialty. But he wasn't surprised that the state allows relatively few people to access this benefit annually because the approval process is so rigorous and the cost is high. “The problem is the drugs are so expensive,” Mitchell said.

Novo Nordisk, which makes Wegovy, said in March it was cutting the monthly price of the drug from $650 to $499 for cash-pay customers. The price health plans and beneficiaries pay for these drugs varies, but some GLP-1s cost more than $1,000 per patient per month, Mitchell said, and many people have to take them for the rest of their lives to maintain weight loss.

“That’s a huge price tag that someone has to foot the bill for,” Mitchell said.

That's why California Gov. Gavin Newsom on May 14 proposed eliminating coverage of GLP-1 for weight loss starting Jan. 1 to save an estimated $680 million per year by 2028.

And the North Carolina State Health Plan board of trustees voted last year to end GLP-1 coverage for state employees after then-North Carolina Treasurer Dale Folwell estimated in 2023 that the drugs were expected to cost the state health plan $1 billion over the next six years. The decision came just months after a separate agency in North Carolina announced it would cover these drugs for Medicaid beneficiaries. North Carolina Medicaid has estimated it will spend $16 million per year on GLP-1.

South Carolina Medicaid, which covers fewer than half of North Carolina Medicaid enrollees, expects to spend less. Lieritz estimated that the GLP-1 and nutritional counseling it provided to South Carolina's Medicaid beneficiaries cost $10 million a year. State funding will cover $3.3 million of the cost. The remainder is paid through matching federal government Medicaid funds.

In a recent statement from Health and Human Services Secretary Robert F. Kennedy Jr., Health and Human Services Secretary Robert F. Kennedy Jr. did not identify the possibility that Medicare and Medicaid could cover the GLP-1 for obesity treatment in the future if costs decline.

They're "exceptional drugs" and "We're going to bring the costs down," Kennedy told CBS News in early April. He said he would like to see GLP-1s eventually made available to Medicare and Medicaid patients seeking treatment for obesity after they have tried other options for losing weight. “That is the framework we are discussing now.”

Meanwhile, public health experts have applauded South Carolina Medicaid's decision to cover GLP-1s. However, the new benefit will not help the vast majority of the 1.5 million adults in South Carolina who are classified as obese, according to data released by the South Carolina Department of Public Health.

“We still have some work to do,” admitted Brannon Traxler, the public health department’s chief medical officer.

However, the state's new "Healthy Eating and Active Living Action Plan," written by a coalition of South Carolina groups including the Department of Public Health, makes no mention of GLP-1s or the role they might play in reducing obesity rates in the state.

The action plan, underwritten by a $1.5 million federal grant, is not intended to identify an overarching approach to reducing obesity in South Carolina, Traxler said. Instead, it encourages physical activity in schools, nutrition and expanding outdoor trails, among other things. A more comprehensive obesity plan might consider the benefits of surgery and GLP-1, but those also carry risks, costs and side effects, Traxler said.

“I think, I think there’s a need to bring everything together,” she said.

On the one hand, Campbell takes the comprehensive approach. In addition to injecting Wegovy once a week, she said, she prioritizes protein intake and moving her body. She also underwent weight loss surgery in late April.

“Weight loss is my biggest goal,” said Campbell, who estimated Wegovy coverage for Medicaid. “It’s one more thing that will help me achieve my goal.”

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