In Mississippi, Medicaid coverage of weight-loss drugs has failed to catch on

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

But in the past two years, her weight has dropped from 600 pounds to 385 pounds, and her blood pressure and blood sugar levels have dropped as well. “I was no longer as tired as I was before, and I was able to return to church,” she said.

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

In a state where the obesity rate ranks among the highest in the country, many health care providers were thrilled when Mississippi Medicaid in 2023 began covering GLP-1s for people 12 and older. Only 13 states cover obesity medications for Medicaid enrollees, and Mississippi’s Medicaid program typically has some fewer benefits and stricter eligibility rules.

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

“It’s a little sad that there are a lot of people who don’t benefit,” said William Rosenblatt, a family physician in Columbus who treats Hines. “These medications get to the root cause of many health conditions.”

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

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

GLP-1s, which Been using it for years For the treatment of type 2 diabetes, it has received widespread attention as a way to lose weight and reduce obesity-related conditions and its long-term costs.

But states may still be reluctant to offer expensive obesity drugs, because Medicaid beneficiaries often turn up or drop coverage as their income changes. Because the health benefits of drugs can take years to realize — such as avoiding a future heart attack — the long-term financial benefits can accrue to other insurers.

Even before the federal cuts, which will largely take effect in 2027, states are already feeling the pinch. Medicaid in North Carolina It dropped its coverage Medicines this month due to their high cost.

Coverage of weight-loss drugs presents a dilemma for the Trump administration, which has made its priorities attacking chronic health conditions and cutting federal spending. Secretary of Health and Human Services Robert F. Kennedy Jr Downplay the need For medications, he said more emphasis should be placed on eating better and exercising more.

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

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

Meanwhile, the Trump administration included the GLP-1 drugs Ozempic, Wegovy and Rybelsus on its list of 15 drugs that would be subject to price negotiations with drug manufacturers under Medicare Part D, a system created during the Biden administration amid opposition from Republicans. The results of those negotiations are expected to be announced this fall.

Most private insurance companies do not cover GLP-1 weight loss treatments, which may make the medications unaffordable for those who pay out of pocket.

Further analysis provided The Mississippi Medicaid Drug Review Board shows that in the first 15 months the drugs were covered, only about 2,900 Medicaid enrollees who were 12 or older started treatment. Nearly 90% were female, and many had high blood pressure and high cholesterol.

The analysis also found that most enrollees who use medications live in the southern, central or northern parts of Mississippi, rather than along the Mississippi Delta on the western side of the state, where obesity rates are highest, at nearly 50%.

About 40% of adults in Mississippi are obese, just one percentage point behind top-ranking West Virginia, according to federal data.

Matt Westerfield, Mississippi’s Medicaid spokesman, told KFF Health News that 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 on the basis that treating obesity would improve the health of enrollees and could ultimately lead to cost savings by reducing diseases caused by obesity.

Although utilization has been below state expectations, those treatment decisions are up to patients and their doctors, Westerfield said. He said the state was working to “raise awareness” of the drugs among health care providers, but declined to comment further.

Some doctors have less incentive to prescribe the drug because the state doesn’t pay them to advise patients on the dietary changes necessary when taking new medications, said Rosenblatt, who works at Baptist Medical Group, part of a large regional health system.

He called the medications a “game changer,” adding that he has seen patients lose 50 pounds or more within a few months of starting the medications and no longer need medications for diabetes or other conditions.

A New England Journal of Medicine study Published in 2021, it found that participants receiving GLP-1 drugs were more likely to show significant and sustained weight loss compared to those who got a placebo.

Other recent studies have shown that medications help obese people lose weight High blood pressure And reduce their chances of infection Heart attacks or strokes.

Mississippi is one of 10 states that did not expand Medicaid eligibility under the Affordable Care Act of 2010 to include everyone with income less than 138% 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 less than 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 document to the state that patients meet certain obesity levels and that there is a treatment plan in place. Doctors must prove that enrollees are losing weight every six months to renew their prescription.

At the Hattiesburg Clinic — a large multispecialty group based in Hattiesburg, Mississippi — Virginia Crawford, a physician who specializes in obesity, said she was surprised by how few patients were getting the medications. A year ago, there were shortages of the drugs that would have prevented doctors from prescribing them. She said state prior authorization requirements for the drug could discourage primary care doctors. Many common medications do not require progress reports 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 her Medicaid coverage, she lost nearly 100 pounds while taking Wegovy.

“It was amazing,” she said of the way the medication dramatically reduced her appetite. “I remember going to the Outback with my husband, and we got an appetizer of onion rings, a 16-ounce ribeye, and a salad with extra ranch dressing. I had some onion rings and started eating the salad and realized I couldn’t eat any more of this.”