As an expert in the field of obesity treatment and medication, I have seen firsthand the struggles that individuals face when trying to lose weight. It is a complex issue that is influenced by a variety of factors, including genetics, diet, and lifestyle. For those who are covered by Medicaid, the process of finding a weight loss medication that is covered can be even more challenging. However, there are options available that may be covered by your state's program. One of the most commonly covered weight loss medications under Medicaid is Wegovy (semaglutide).
This medication, along with Saxenda (liraglutide) and others, can be prescribed to treat obesity in individuals aged 12 and older. These medications have been approved by the Food and Drug Administration (FDA) and have shown promising results in helping individuals lose weight. While some states have been offering limited coverage for GLP-1 medications for weight loss for over a decade, it has only been in the last five years that most states have started providing coverage through their Medicaid programs or health plans for state employees. As of March 2025, 11 states offered coverage for GLP-1 medications under their state employee health plans, nine states offered coverage under their state Medicaid programs, and five states offered coverage under both programs. A recent analysis conducted by the Kaiser Family Foundation (KFF) revealed that most large employers do not cover GLP-1 drugs for weight loss, and coverage through Affordable Care Act (ACA) market plans remains limited. Additionally, Medicare does not currently cover these medications.
This has put pressure on state Medicaid budgets, leading officials to consider various strategies to reduce costs and reevaluate their approach to obesity treatment as a whole. One of the main reasons that states are considering coverage for GLP-1 medications is to promote health equity. This means that all individuals, regardless of their background, deserve equal access to healthcare. However, the rising costs of these medications are a concern for state officials. Liz Williams, a senior policy analyst at KFF and co-author of a survey of state Medicaid programs, explains that while states want to provide coverage, they also need to consider the impact on their budgets. GLP-1 agonists, such as Wegovy and Saxenda, have been shown to not only help with weight loss but also improve blood sugar levels and reduce the risk of major cardiovascular events like heart attacks and strokes.
However, some states have faced similar cost problems as Colorado and have had to stop including GLP-1 weight loss coverage in their state employee health plans. The Alliance to Stop Obesity has partnered with the Obesity Action Coalition to discuss how states cover obesity treatment in their Medicaid programs. Medications that are specifically covered for the treatment of obesity (not for treating type 2 diabetes with obesity as a secondary condition) have been given a total value of "4". North Carolina's Medicaid program is adding coverage for GLP-1 medications due to the significant weight loss associated with these drugs and their impact on comorbidities. While GLP-1 medications may be covered for the treatment of obesity, Medicaid programs are required to cover formulations used to treat type 2 diabetes. This includes medications like Ozempic (semaglutide), Rybelsus (semaglutide), Victoza (liraglutide), and Mounjaro (tirzepatide).
Covered drugs must also be from manufacturers enrolled in the Medicaid drug discount program and have an FDA-approved indication for the treatment of obesity. For many individuals struggling with obesity, losing weight is not as simple as eating healthier and exercising more. There are often underlying factors, such as genetics and access to healthy food, that make it difficult to lose weight. This is especially true for those covered by Medicaid, who may face additional challenges such as busy schedules and a lack of resources like daycare centers. In order to provide a comprehensive understanding of Medicaid coverage for GLP-1 medications, data and analysis were gathered on the categories of obesity treatments offered and the level of coverage provided by state Medicaid programs. This included both new generation medications like Saxenda and Wegovy, as well as previous generation medications like Contrave, Qysmia, and phentermine. The data was collected using AXIACI, a unique resource provided by LEVERAGE that focuses on the structural and organizational characteristics of Medicaid programs and the details of plan coverage.
This information is crucial for understanding the current landscape of obesity treatment coverage under Medicaid and the potential implications of expanding coverage for anti-obesity drugs.
