California Ends Medicaid Coverage of Weight Loss Drugs Despite TrumpRx Plan

SACRAMENTO, Calif. — Many low-income Californians who were taking popular weight-loss drugs lost their coverage for those drugs early in the new year.

Health officials recommend diet and exercise as alternatives to heavily advertised weight-loss drugs like Wegovy and Zepbound, advice that experts say is unrealistic.

“Of course he tried to eat well and everything, but now with the medication it’s better – a 100 percent change,” said Wilmer Cardenas of Santa Clara, who said her husband lost about 100 pounds in two years using GLP-1s covered by Medi-Cal, California’s version of Medicaid.

California has joined several other states in restricting an option they say is no longer affordable as they face soaring pharmaceutical costs and deep cuts to Medicaid under the Trump administration, among other financial pressures. Despite negotiated price reductions announced in November that the White House said would make the drugs available at “significantly lower cost to taxpayers” and allow Medicaid to cover them, states are continuing these reductions, which providers say could harm patients’ health.

“It will be quite negative for our patients” because data shows that people generally regain weight after stopping medications, said Diana Thiara, medical director of the weight management program at the University of California, San Francisco.

While California, New Hampshire, Pennsylvania and South Carolina stopped covering adult GLP-1 prescriptions for obesity on January 1, they continue to cover the drugs for other health conditions, such as type 2 diabetes, cardiovascular disease and chronic kidney disease.

Michigan, Rhode Island and Wisconsin are planning or considering restrictions, according to KFF’s most recent survey.

This reverses a trend that saw 16 states cover obesity medications as of October 1. Interest in coverage “appears to be declining,” the survey found, likely due to drug costs and other state budget pressures. North Carolina removed GLP-1 coverage in October, but Gov. Josh Stein reinstated it in December, complying with court orders despite a persistent budget deficit.

Catherine Ferguson, vice president of federal advocacy for the American Diabetes Association and its affiliate Obesity Association, said it was unclear how states would adapt to the White House plan to reduce the cost of several of the most popular GLP-1s through TrumpRx, an online portal for discounted prescription drugs. Wegovy’s price, for example, will be $350 a month for consumers, up from the current list price of nearly $1,350, and the Medicare and Medicaid programs will pay $245, according to the plan.

“Many states are facing budgetary challenges, such as deficits, and working to address the impacts of changes to Medicaid and SNAP,” Ferguson wrote, referring to the Supplemental Nutrition Assistance Program. “As more details become available about the administration’s agreements, we will see how State Medicaid responds.”

The Department of Health and Human Services referred questions to the White House, which did not respond to requests for comment on states’ termination of Medicaid coverage for weight-loss drugs.

California projected that its costs to cover GLP-1s for weight loss would have more than quadrupled over four years to nearly $800 million a year if it had not ended Medi-Cal coverage for this use. Medi-Cal has covered weight-loss drugs since 2006, but GLP-1 use has only skyrocketed in recent years. In 2024, more than 645,000 prescriptions were covered by Medi-Cal for all drug uses. The California Department of Health Services could not easily determine whether the drugs were for weight loss or other conditions.

Asked if the state would reconsider its plans in light of the announced price cuts, Department of Finance spokesman HD Palmer said it had no plans to do so. The California reduction is written into state budget law.

California officials would not say how much they could save through the TrumpRx plan, citing federal and state restrictions on disclosing rebate information.

Health care providers don’t expect the price reductions negotiated by the Trump administration to make much of a difference to consumers because drug companies already offer discounts.

“Out-of-pocket costs will remain very prohibitive for most, especially for people with Medicaid insurance,” Thiara said.

New Hampshire is among other states that ended their coverage on January 1. Officials with the New Hampshire Department of Health and Human Services did not respond to requests for comment.

About 1 in 8 adults now take a GLP-1 drug for obesity, disease, or both, an increase of 6 percentage points from May 2024, according to KFF poll results released in November. More than half of users said their GLP-1s were difficult to afford, and many of those who stopped treatment cited cost.

Public and private payers have attempted to wean patients off to reduce costs. California health officials said Medi-Cal members and their health care providers should consider “other treatment options that may promote weight loss, such as diet changes, increased activity or exercise, and counseling.” This echoes advice from New Hampshire’s Medicaid program.

California Department of Health Services spokeswoman Tessa Outhyse said in an email that the official advice to try these other approaches now “is not intended to dismiss past efforts, but to encourage Medi-Cal members to take a renewed, proactive, medically supported approach with their health care provider that may appropriately include these additional options.”

But that might be unrealistic, said Kurt Hong, founding director of the Clinical Nutrition Center at the University of Southern California’s Keck School of Medicine.

“We definitely want patients to do their part when it comes to diet and exercise, but unfortunately, and from a practical standpoint, that’s often not enough,” Hong said, adding that usually by the time patients visit the doctor, they have already failed to achieve results through these means.

Hong understands why Medicaid programs, as well as private providers, want to cut coverage for drugs, which can cost thousands of dollars per patient per year. However, they can cause twice the weight loss of previously typically used medications, he said.

One school of medical thought supports patients gradually stopping consumption, but Hong said obesity is generally considered a chronic disease requiring treatment for an indefinite period of time.

“Once they reach their goal weight, a lot of people will try to see whether or not they can wean themselves off,” Hong said. “We see a lot of patients. When they try to come down, unfortunately, the weight comes back.”

Medi-Cal members under 21 remain covered, including for weight loss, California officials said, citing a federal requirement.

Medi-Cal members can keep their GLP-1 coverage if they can demonstrate that it is medically necessary for purposes other than weight loss, the department said. Members who are denied coverage can request a hearing, the department said in a letter to members.

Members will still be able to pay for prescriptions out of pocket and will be able to benefit from various discounts to reduce costs. Another option is to create new pills to treat obesity, which will be cheaper than their injectable counterparts. The FDA approved a pill version of Wegovy on Dec. 22, which will likely cost $149 per month for the lowest dose, and similar diet pills are expected to be available within the first half of the year.

While Cardenas said her husband, Jeffer Jimenez, 37, uses GLP-1s primarily for weight loss, Jimenez’s prescription is for his diabetes, so the couple hoped to continue coverage through Medi-Cal.

“He tried a thousand medications, pills, natural teas, exercise programs, but it doesn’t work like injections,” Cardenas said. “You need both.”