Tags: #GLP1Coverage #MedicaidWeightLoss #ObesityTreatment #Wegovy #SouthCarolinaMedicaid #TrumpMedicaidPolicy #WeightLossDrugs #BariatricSurgery #HealthcarePolicy #ObesityCrisis
Federal Block on GLP-1 Coverage for Obesity
The Trump administration has decided against finalizing a proposed rule that would have allowed Medicaid and Medicare to cover GLP-1 drugs, such as Wegovy, for obesity treatment. This decision impacts an estimated 7.4 million beneficiaries who could have accessed these medications for weight loss. Despite this, a few states, including South Carolina, have independently chosen to cover these costly drugs for Medicaid recipients, highlighting a growing divide in healthcare policy.
South Carolina’s Bold Move to Cover GLP-1s
In late 2024, South Carolina became the 14th state to include GLP-1s in its Medicaid program for obesity treatment. This decision benefits individuals like Page Campbell, a 40-year-old single mother from Charleston, who uses Wegovy alongside lifestyle changes and bariatric surgery. However, the state estimates only 1,300 beneficiaries will qualify due to stringent requirements, including proof of prior unsuccessful weight loss attempts through diet and exercise.
Rigorous Approval Process Limits Access
Accessing GLP-1 coverage under South Carolina Medicaid is challenging. Beneficiaries must provide six months of documentation showing failed weight loss efforts after nutrition counseling and a 1,200-calorie daily diet. Once approved, patients like Campbell must demonstrate at least 5% body weight loss and ongoing counseling to maintain coverage. This rigorous process, combined with the high cost of GLP-1s—sometimes exceeding $1,000 per month—limits the number of eligible recipients.
Page Campbell’s Journey with Wegovy
Page Campbell, a shipping manager and mother of two, began using Wegovy in early 2025 to prepare for bariatric surgery. Weighing 314 pounds at her last appointment, she has embraced exercise and healthier eating habits without experiencing side effects like nausea. Campbell’s determination reflects the potential of GLP-1s when paired with lifestyle changes, though she avoids tracking her weight at home, focusing instead on her overall progress.
Cost Concerns and State Budget Impacts
The high cost of GLP-1s poses a significant challenge. South Carolina Medicaid anticipates spending $10 million annually on these drugs and related counseling, with $3.3 million covered by state funds and the rest by federal matching funds. In contrast, states like California and North Carolina have moved to limit or eliminate GLP-1 coverage due to budget constraints, with California projecting savings of $680 million annually by 2028 by cutting this benefit.
Debate Over Obesity Treatment Strategies
While South Carolina’s decision has been praised by public health experts, the state’s broader obesity strategy does not yet fully integrate GLP-1s. The “Action Plan for Healthy Eating and Active Living,” supported by a $1.5 million federal grant, focuses on promoting physical activity and nutrition but omits mention of pharmacological interventions. Experts acknowledge the need for a comprehensive approach that balances the benefits and risks of drugs like Wegovy.
Future Prospects for GLP-1 Coverage
Health and Human Services Secretary Robert F. Kennedy Jr. has suggested that GLP-1s could become more accessible as costs decrease, calling them “extraordinary drugs.” However, with federal support unlikely in the near term and the FDA set to restrict cheaper compounded versions, access remains limited. States like South Carolina are forging ahead, but the majority of the 1.5 million obese adults in the state still lack access to these transformative medications.
Leave a Reply