COLUMBUS, Miss. — April Hines has battled along with her weight since she was a teen.
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 stated.
Hines, 46, credit her weight reduction to Trulicity, a part of a brand new class of pricey weight reduction medication generally known as GLP-1s, and her Medicaid protection for it. “It’s a blessing,” she stated.
In a state the place the weight problems price ranks among the many highest within the nation, many well being suppliers have been thrilled when Mississippi Medicaid in 2023 started protecting 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 a few of the sparsest advantages and strictest eligibility guidelines.
Hines is one in all comparatively few enrollees to have used the brand new Medicaid profit, which weight reduction medical doctors 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, in keeping with a report to the state’s Medicaid Drug Utilization Assessment Board.
“It’s just a little unhappy to have so many individuals on the market not benefiting,” stated William Rosenblatt, a household physician in Columbus who treats Hines. “These medication get to the foundation reason for so many well being circumstances.”
Already-scarce Medicaid protection of the extremely touted weight reduction medication may change into extra restricted, with federal Medicaid funding cuts anticipated within the wake of the huge tax-and-spending invoice President Donald Trump signed into legislation in July. The Congressional Funds Workplace estimated that the legislation would scale back Medicaid spending by about $911 billion over a decade.
“The legislation goes to create pretty intense stress on states to not broaden advantages,” stated Michael Kolber, a companion within the well being consulting agency Manatt. That could be very true for these medication, which regularly value round $1,000 a month and could possibly be utilized by a big share of Medicaid recipients, he stated.
GLP-1s, which have been used for years to deal with Kind 2 diabetes, have gained widespread consideration as a method to drop a few 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 earnings adjustments. And since the medication’ well being advantages could take years to materialize — similar to averting a future coronary heart assault — the long-term monetary benefits may 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 value.
Protection for the burden loss medication presents a dilemma for the Trump administration, which has recognized as priorities attacking continual well being circumstances and lowering federal spending. Well being and Human Companies Secretary Robert F. Kennedy Jr. has downplayed the necessity for the medication and stated 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 sort out 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 Publish reported the Trump administration was contemplating a five-year pilot program for Medicare and Medicaid to cowl the medication in any case. No particulars have been launched. Requested for touch upon the report, Facilities for Medicare & Medicaid Companies spokesman Alexx Pons instructed KFF Well being Information that every one choices undergo a cost-benefit assessment.
In the meantime, the Trump administration has included the GLP-1 medication Ozempic, Wegovy, and Rybelsus on its record of 15 medicines that can be topic to cost negotiations with pharmaceutical producers below 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 offered to Mississippi’s Medicaid drug assessment board exhibits that, within the first 15 months the medication have been lined, solely about 2,900 Medicaid enrollees age 12 or older began therapy. Almost 90% of them have been feminine, and plenty 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 almost 50%.
About 40% of adults in Mississippi are overweight, only one share level behind top-ranked West Virginia, in keeping with federal knowledge.
Mississippi Medicaid spokesman Matt Westerfield instructed 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 stated the state accepted the brand new medication on the logic that treating weight problems would enhance enrollees’ well being and finally may result in value financial savings by lowering ailments attributable to weight problems.
Westerfield stated that whereas utilization has been under the state’s projections, such therapy choices are as much as sufferers and their medical doctors. He stated 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, stated some medical doctors have much less incentive to prescribe the drugs, as a result of the state doesn’t pay them to counsel sufferers about vital 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 now not want drugs for diabetes or different circumstances.
A New England Journal of Drugs research printed in 2021 discovered individuals receiving GLP-1 medication have 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 in all 10 states that haven’t expanded Medicaid eligibility below the 2010 Inexpensive Care Act to everybody with an earnings below 138% of federal poverty degree, or $21,597 this 12 months.
In Mississippi, Medicaid doesn’t cowl adults with out dependent youngsters. Mother and father qualify provided that their earnings is under 22% of the federal poverty degree, or $5,863 for a household of three this 12 months.
The state’s prior authorization course of requires medical doctors to doc to the state that sufferers meet sure weight problems ranges and {that a} therapy plan is in place. Medical doctors should reveal that enrollees are shedding 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 makes a speciality of weight problems, stated she was shocked so few sufferers are getting the medication. A 12 months in the past, there have been shortages of the medication that would have curtailed physicians prescribing them. And he or she stated the state’s prior authorization necessities for the drug may discourage major care medical doctors. Many widespread drugs don’t require progress stories and even prior authorization.
“We have to make sufferers extra conscious that this feature is offered for them,” she stated.
Lauren Scott, 40, of Laurel, Mississippi, stated that with the assistance of Medicaid protection, she misplaced almost 100 kilos taking Wegovy.
“It’s simply been superb,” she stated of how the drug drastically lower her urge for food. “I bear in mind going to Outback with my husband, and we bought 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.”
