In Mississippi, Medicaid Coverage of Weight Loss Drugs Fails to Catch On

COLUMBUS, Miss. – April Hines has struggled with her weight since she was a teenager.

But over the past two years, she has gone from 600 pounds to 385 pounds, along with her blood pressure and blood sugar levels. “I’m not as tired as I used to be and I was able to go back to church,” she said.

Hines, 46, attributes his weight loss to Trulicity, part of a new class of expensive weight-loss drugs known as GLP-1, and his Medicaid coverage. “It’s a blessing,” she said.

In a state with among the highest obesity rates in the nation, many health care providers were pleased when Mississippi Medicaid in 2023 began covering GLP-1s for people 12 and older. Only 13 states cover medications for obese people enrolled in Medicaid, and Mississippi’s Medicaid program generally offers some of the rarest benefits and strictest eligibility rules.

Hines is one of the few enrollees who have used the new Medicaid benefit, which state doctors say has been hampered by national drug shortages, the state’s prior authorization process for drugs and a lack of marketing. Only 2% of adults on Mississippi Medicaid who meet weight-related criteria were prescribed a GLP-1 as of December 2024, according to a report from the state’s Medicaid Drug Utilization Review Board.

“It’s a little sad to see that so many people aren’t getting it,” said William Rosenblatt, a Columbus family doctor who treats Hines. “These medications address the root cause of so many health problems. »

Already scarce Medicaid coverage of the much-touted weight-loss drugs could become more limited, with reductions in federal Medicaid funding expected following the massive tax and spending bill signed by President Donald Trump in July. The Congressional Budget Office estimated that the law would reduce Medicaid spending by about $911 billion over a decade.

“The law is going to create pretty intense pressure on states not to expand benefits,” said Michael Kolber, a partner at health consulting firm Manatt. That may be especially true for these drugs, which often cost about $1,000 a month and could be used by a significant percentage of Medicaid beneficiaries, he said.

GLP-1s, used for years to treat type 2 diabetes, have gained attention as a way to lose weight and reduce obesity-related conditions and their long-term costs.

But states may remain reluctant to offer expensive obesity drugs because Medicaid recipients often shift to coverage based on changes in their income. And because the health benefits of drugs can take years to materialize — such as preventing a future heart attack — the long-term financial benefits could accrue to other insurers.

Even before the federal budget cuts, which will largely take effect in 2027, states are already feeling the effects. North Carolina’s Medicaid program dropped coverage of the drugs this month, citing their high cost.

Coverage for weight-loss drugs presents a dilemma for the Trump administration, which has identified fighting chronic diseases and reducing federal spending as priorities. Health and Human Services Secretary Robert F. Kennedy Jr. has downplayed the need for the drugs and said more emphasis should be placed on better diet and more physical activity.

In 2024, the Biden administration proposed that Medicare and Medicaid cover weight-loss drugs to help combat obesity as a public health crisis. In April, the Trump administration revoked the Biden-era proposal, saying the programs would not cover GLP-1 weight loss drugs.

But in August, the Washington Post reported that the Trump administration was considering a five-year pilot program for Medicare and Medicaid to eventually cover the drugs. No details have been released. Asked to comment on the report, Centers for Medicare & Medicaid Services spokesperson Alexx Pons told KFF Health News that all decisions go through a cost-benefit review.

Meanwhile, the Trump administration included the GLP-1 drugs Ozempic, Wegovy and Rybelsus on its list of 15 drugs that will be subject to price negotiations with pharmaceutical manufacturers under its Medicare Part D program, a system created under the Biden administration in the face of Republican opposition. The results of these negotiations are expected to be announced this fall.

Most private insurers do not cover GLP-1 for weight loss, which can make the drugs unaffordable for those paying out of pocket.

Further analysis provided to the Mississippi Medicaid Drug Review Board shows that in the first 15 months the drugs were covered, only about 2,900 Medicaid enrollees aged 12 or older began treatment. Nearly 90% of them were women and many suffered from high blood pressure and high cholesterol.

The analysis also found that most enrollees using these drugs lived in south, central or north Mississippi, not along the Mississippi Delta in the west of the state, where obesity rates are highest at nearly 50 percent.

About 40 percent of Mississippi adults are obese, just one percentage point behind West Virginia, according to federal data.

Mississippi Medicaid spokesman Matt Westerfield told KFF Health News the state spent $12 million in the first 15 months, providing weight-loss medications to 2,200 adult members. He said the state approved the new drugs based on the logic that treating obesity would improve the health of enrollees and could potentially lead to cost savings by reducing diseases caused by obesity.

Westerfield said that while utilization has been lower than state projections, those treatment decisions are up to patients and their doctors. He said the state has “educated” health care providers about the drugs, but he declined to comment further.

Rosenblatt, who works for Baptist Medical Group, which is part of a large regional health system, said some doctors have less incentive to prescribe the drug because the state doesn’t pay them to advise patients on necessary dietary changes when they take the new drugs.

He called the drugs “game changers,” adding that he has seen patients lose 50 pounds or more within months of starting them and no longer need medications for diabetes or other illnesses.

A New England Journal of Medicine study published in 2021 found that participants receiving GLP-1 drugs were more likely to experience significant and sustained weight loss than those receiving a placebo.

Other recent studies have shown that the drugs help obese people lower their high blood pressure and reduce their risk of heart attack or stroke.

Mississippi is one of 10 states that did not expand Medicaid eligibility under the Affordable Care Act of 2010 to anyone with income below 138 percent of the federal poverty level, or $21,597 this year.

In Mississippi, Medicaid does not cover adults without dependent children. Parents are only eligible if their income is below 22% of the federal poverty level, or $5,863 for a family of three this year.

The state’s prior authorization process requires doctors to prove to the state that patients reach certain levels of obesity and that a treatment plan is in place. Doctors must demonstrate that enrollees are losing weight every six months to refill their prescription.

At the Hattiesburg Clinic — a large multi-specialty group based in Hattiesburg, Miss. — Virginia Crawford, a physician who specializes in obesity, said she was surprised that so few patients received the drugs. A year ago, drug shortages might have stopped doctors from prescribing them. And she said the state’s prior authorization requirements for the drug could discourage primary care doctors. Many common medications do not require a progress report or even prior authorization.

“We need to make patients more aware that this option is available to them,” she said.

Lauren Scott, 40, of Laurel, Mississippi, said that with the help of Medicaid coverage, she lost nearly 100 pounds while taking Wegovy.

“It was just amazing,” she said of how the drug significantly suppressed her appetite. “I remember going to the Outback with my husband, and we had the onion ring appetizer and a 16-ounce rib-eye and a salad with extra ranch dressing. I ate the onion rings and started the salad and realized I couldn’t eat any more.”