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In a state the place the weight problems charge ranks among the many highest within the nation, many well being suppliers have been thrilled when Mississippi Medicaid in 2023 started masking GLP-1s for individuals 12 and older. Solely 13 states cowl the medicine for Medicaid enrollees for weight problems, and Mississippi’s Medicaid program sometimes has a few of the sparsest advantages and strictest eligibility guidelines.
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 back to the state’s Medicaid Drug Utilization Evaluate Board.
“It’s a little sad to have so many people out there not benefiting,” stated William Rosenblatt, a household physician in Columbus. “These drugs get to the root cause of so many health conditions.”
Already-scarce Medicaid protection of the extremely touted weight reduction medicine might develop into extra restricted, with federal Medicaid funding cuts anticipated within the wake of the large tax-and-spending invoice President Donald Trump signed into legislation in July. The Congressional Price range Workplace estimated that the legislation would cut back Medicaid spending by about $911 billion over a decade.
“The law is going to create fairly intense pressure on states not to expand benefits,” stated Michael Kolber, a accomplice within the well being consulting agency Manatt. Which may be very true for these medicine, which frequently price round $1,000 a month and may very well be utilized by a big proportion of Medicaid recipients, he stated.
GLP-1s, which have been used for years to deal with sort 2 diabetes, have gained widespread consideration as a option to drop some weight and scale back obesity-related situations and their long-term prices.
However states could stay reluctant to supply the costly medicine for weight problems, as a result of Medicaid recipients regularly churn on and off the protection as their revenue modifications. And since the medicine’ well being advantages could take years to materialize—resembling averting a future coronary heart assault—the long-term monetary benefits might accrue to different insurers.
Even forward of the federal cuts, which is able to largely take impact in 2027, states are already feeling the pinch. North Carolina’s Medicaid program dropped its protection of the medicine this month, citing their excessive price.
Protection for the burden loss medicine presents a dilemma for the Trump administration, which has recognized as priorities attacking persistent well being situations and lowering federal spending. Well being and Human Providers Secretary Robert F. Kennedy Jr. has downplayed the necessity for the medicine 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 medicine 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 medicine for weight reduction.
In the meantime, the Trump administration has included the GLP-1 medicine Ozempic, Wegovy, and Rybelsus on its listing of 15 medicines that will likely be topic to cost negotiations with pharmaceutical producers underneath its Medicare Half D program, a system created throughout the Biden administration amid opposition from Republicans. The outcomes of these negotiations are anticipated to be introduced this fall.
Most personal insurers do not cowl GLP-1s for weight reduction, which may make the medicine unaffordable for these paying out of pocket.
Additional evaluation supplied to Mississippi’s Medicaid drug evaluate board reveals that, within the first 15 months the medicine have been coated, solely about 2,900 Medicaid enrollees age 12 or older began therapy. Practically 90% of them have been feminine, and plenty of had hypertension and excessive ldl cholesterol.
The evaluation additionally discovered most enrollees utilizing the medicine lived within the southern, central, or northern components of Mississippi—not alongside the Mississippi Delta on the western aspect of the state, the place weight problems charges are highest, at almost 50%.
About 40% of adults in Mississippi are overweight, only one proportion level behind top-ranked West Virginia, based on federal knowledge.
Westerfield stated that whereas utilization has been under the state’s projections, such therapy choices are as much as sufferers and their docs. He stated the state has been “raising awareness” of the medicine amongst well being care suppliers, however he declined to remark additional.
Rosenblatt, who works for Baptist Medical Group, half of a big regional well being system, stated some docs have much less incentive to prescribe the drugs, as a result of the state would not pay them to counsel sufferers about obligatory dietary modifications when taking the brand new medicine.
He known as the medicine “game changers,” including that he has seen sufferers lose 50 kilos or extra inside a couple of months of beginning the medicine and now not want drugs for diabetes or different situations.
A New England Journal of Drugs research printed in 2021 discovered individuals receiving GLP-1 medicine have been extra prone to present important, sustained weight reduction in contrast with these getting a placebo.
Different latest research have proven the medicine assist individuals with weight problems decrease their hypertension and scale back their odds of coronary heart assaults or strokes.
Mississippi is one among 10 states that haven’t expanded Medicaid eligibility underneath the 2010 Reasonably priced Care Act to everybody with an revenue underneath 138% of federal poverty stage, or $21,597 this yr.
In Mississippi, Medicaid doesn’t cowl adults with out dependent youngsters. Dad and mom 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} therapy plan is in place. Medical doctors should display 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 focuses on weight problems, stated she was stunned so few sufferers are getting the medicine.
A yr in the past, there have been shortages of the medicine that might have curtailed physicians prescribing them. And he or she stated the state’s prior authorization necessities for the drug might discourage main care docs. Many widespread drugs don’t require progress stories and even prior authorization.
“We need to make patients more aware that this option is available for them,” she stated.
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In Mississippi, Medicaid protection of weight reduction medicine fails to catch on (2025, October 21)
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