COLUMBUS, Miss. — April Hines has battled along with her weight since she was an adolescent.
However previously couple of years, she’s fallen from 600 kilos to 385, and her blood stress and blood sugar ranges are down, too. “I’m not as fatigued as I was, and I’ve been ready to return to church,” she mentioned.
Hines, 46, credit her weight reduction to Trulicity, a part of a brand new class of high-priced weight reduction medication referred to as GLP-1s, and her Medicaid protection for it. “It’s a blessing,” she mentioned.
In a state the place the weight problems fee ranks among the many highest within the nation, many well being suppliers had been thrilled when Mississippi Medicaid in 2023 started overlaying GLP-1s for individuals 12 and older. Solely 13 states cowl the medication for Medicaid enrollees for weight problems, and Mississippi’s Medicaid program sometimes has among the sparsest advantages and strictest eligibility guidelines.
Hines is one among comparatively few enrollees to have used the brand new Medicaid profit, which weight reduction docs within the state say has been hindered by nationwide drug shortages, the state’s prior authorization course of for the medication, and an absence of selling. Simply 2% of adults on Mississippi Medicaid who meet the weight-related standards had been prescribed a GLP-1 as of December 2024, based on a report to the state’s Medicaid Drug Utilization Evaluation Board.
“It’s a little bit unhappy to have so many individuals on the market not benefiting,” mentioned William Rosenblatt, a household physician in Columbus who treats Hines. “These medication get to the foundation explanation for so many well being circumstances.”
Already-scarce Medicaid protection of the extremely touted weight reduction medication might turn out to be extra restricted, with federal Medicaid funding cuts anticipated within the wake of the large tax-and-spending invoice President Donald Trump signed into regulation in July. The Congressional Finances Workplace estimated that the regulation would scale back Medicaid spending by about $911 billion over a decade.
“The regulation goes to create pretty intense stress on states to not develop advantages,” mentioned Michael Kolber, a associate within the well being consulting agency Manatt. Which may be very true for these medication, which frequently price round $1,000 a month and could possibly be utilized by a big share of Medicaid recipients, he mentioned.
GLP-1s, which have been used for years to deal with Kind 2 diabetes, have gained widespread consideration as a technique to drop some pounds and cut back obesity-related circumstances and their long-term prices.
However states could stay reluctant to supply the costly medication for weight problems, as a result of Medicaid recipients incessantly churn on and off the protection as their revenue adjustments. And since the medication’ well being advantages could take years to materialize — corresponding to averting a future coronary heart assault — the long-term monetary benefits might accrue to different insurers.
Even forward of the federal cuts, which can largely take impact in 2027, states are already feeling the pinch. North Carolina’s Medicaid program dropped its protection of the medication this month, citing their excessive price.
Protection for the burden loss medication presents a dilemma for the Trump administration, which has recognized as priorities attacking continual well being circumstances and decreasing federal spending. Well being and Human Companies Secretary Robert F. Kennedy Jr. has downplayed the necessity for the medication and mentioned extra emphasis must be positioned on consuming higher and exercising extra.
In 2024, the Biden administration proposed that Medicare and Medicaid cowl weight reduction medication to assist deal with weight problems as a public well being disaster. In April, the Trump administration revoked the Biden-era proposal, saying the applications wouldn’t cowl GLP-1 medication for weight reduction.
However in August, The Washington Submit reported the Trump administration was contemplating a five-year pilot program for Medicare and Medicaid to cowl the medication in spite of everything. No particulars have been launched. Requested for touch upon the report, Facilities for Medicare & Medicaid Companies spokesman Alexx Pons advised KFF Well being Information that each one choices undergo a cost-benefit evaluate.
In the meantime, the Trump administration has included the GLP-1 medication Ozempic, Wegovy, and Rybelsus on its record of 15 medicines that will probably be topic to cost negotiations with pharmaceutical producers beneath its Medicare Half D program, a system created through the Biden administration amid opposition from Republicans. The outcomes of these negotiations are anticipated to be introduced this fall.
Most personal insurers don’t cowl GLP-1s for weight reduction, which might make the medication unaffordable for these paying out of pocket.
Additional evaluation supplied to Mississippi’s Medicaid drug evaluate board exhibits that, within the first 15 months the medication had been lined, solely about 2,900 Medicaid enrollees age 12 or older began remedy. Almost 90% of them had been feminine, and lots of had hypertension and excessive ldl cholesterol.
The evaluation additionally discovered most enrollees utilizing the medication lived within the southern, central, or northern elements of Mississippi — not alongside the Mississippi Delta on the western facet of the state, the place weight problems charges are highest, at practically 50%.
About 40% of adults in Mississippi are overweight, only one share level behind top-ranked West Virginia, based on federal information.
Mississippi Medicaid spokesman Matt Westerfield advised KFF Well being Information that the state spent $12 million within the first 15 months, offering the burden loss medication to 2,200 grownup members. He mentioned the state permitted the brand new medication on the logic that treating weight problems would enhance enrollees’ well being and finally might result in price financial savings by decreasing illnesses attributable to weight problems.
Westerfield mentioned that whereas utilization has been under the state’s projections, such remedy choices are as much as sufferers and their docs. He mentioned the state has been “elevating consciousness” of the medication amongst well being care suppliers, however he declined to remark additional.
Rosenblatt, who works for Baptist Medical Group, half of a giant regional well being system, mentioned some docs have much less incentive to prescribe the drugs, as a result of the state doesn’t pay them to counsel sufferers about obligatory dietary adjustments when taking the brand new medication.
He known as the medication “sport changers,” including that he has seen sufferers lose 50 kilos or extra inside just a few months of beginning the medication and not want medicines for diabetes or different circumstances.
A New England Journal of Medication research revealed in 2021 discovered individuals receiving GLP-1 medication had been extra more likely to present vital, sustained weight reduction in contrast with these getting a placebo.
Different current research have proven the medication assist individuals with weight problems decrease their hypertension and cut back their odds of coronary heart assaults or strokes.
Mississippi is one among 10 states that haven’t expanded Medicaid eligibility beneath the 2010 Reasonably priced Care Act to everybody with an revenue beneath 138% of federal poverty stage, or $21,597 this yr.
In Mississippi, Medicaid doesn’t cowl adults with out dependent youngsters. Mother and father qualify provided that their revenue is under 22% of the federal poverty stage, or $5,863 for a household of three this yr.
The state’s prior authorization course of requires docs to doc to the state that sufferers meet sure weight problems ranges and {that a} remedy plan is in place. Medical doctors should reveal that enrollees are dropping pounds each six months to resume their prescription.
On the Hattiesburg Clinic — a big, multi-specialty group with a location in Hattiesburg, Mississippi — Virginia Crawford, a doctor who focuses on weight problems, mentioned she was stunned so few sufferers are getting the medication. A yr in the past, there have been shortages of the medication that might have curtailed physicians prescribing them. And he or she mentioned the state’s prior authorization necessities for the drug might discourage main care docs. Many widespread medicines don’t require progress experiences and even prior authorization.
“We have to make sufferers extra conscious that this selection is obtainable for them,” she mentioned.
Lauren Scott, 40, of Laurel, Mississippi, mentioned that with the assistance of Medicaid protection, she misplaced practically 100 kilos taking Wegovy.
“It’s simply been superb,” she mentioned of how the drug drastically lower her urge for food. “I keep in mind going to Outback with my husband, and we acquired the onion ring appetizer and 16-ounce ribeye and salad with further ranch dressing. I had some onion rings and began on the salad and realized I couldn’t eat any extra of this.”
