In Wisconsin, spending on GLP-1S for obesity alone jumped more than 500 percent in two years, rising from 20 percent in 2024 to more Medicaid exrolerees starting to take the drug.
“Managing costs while preserving access to care is always a consideration for state Medicaid programs,” a spokesperson for the Wisconsin Department of Health said in an email. “Wisconsin is looking at cost trends for these drugs and exploring options to balance costs and access.”
Obesity is a major problem in the State known as America’s Dairyland, where 38 percent of adults struggle with this disease, according to the American Diabetes Association.
The Wisconsin vaccine is causing headaches for doctors and patients who have seen the health-threatening benefits of the treatment. Doctors say this policy ignores clinical evidence – most patients need to stay on drugs to maintain weight loss. They also argued that there is no financial benefit because covering drugs only for a short time will not help reduce the rates of expensive diseases such as diabetes and heart disease in the future.
“Paying patients to have two shots and knowing that there might be a repeat after that, you can’t see your return on investment,” Golven said.
Patients like Daly and Higgins are still eschewing the fortune of living in one of the 16 countries that offer coverage for anti-obesity drugs for pet patients. Medicaid patients. They are thankful that they had access to medication, if only for a short time.
They also worry about losing access.
“I try not to think about it too much, because when I do, it gets me down,” Daly said. “I’m worried about that. It’s always in the back of my mind: What will happen when that day comes?”
Millions of Medicaid patients with obesity in 34 states across the country have little access to GLP-1s for weight loss.
That’s partly because of the Federal-Old Faferal Act, which obese doctors argue is being discriminated against.
In 1990, Congress passed laws that exempted weight loss drugs from mandatory elimination from Medicaid and Medicare, the Federal Health Insurance Program for the elderly. The law was intended to contain costs.
At the time, the prevailing opinion was that obesity should be treated with lifestyle changes, and many weight loss drugs on the market raised safety concerns. Some have been linked to life-threatening heart and lung conditions. The FDA banned some of the drugs.
“It’s based on assumptions about obesity,” said John Cawley, a professor of public policy and economics at Cornell University who studies the costs of obesity and believes it should be considered a chronic disease. “It’s based on a country where there was no effective and safe option.”
GLP-1S, which has been used for years to treat diabetes, is safe and perhaps the most effective option for treating diabetes, say doctors who work closely with the disease. Medicines work by mimicking a hormone in the body that helps regulate insulin and glucose levels, making people feel full.
Doctors say the Federal policy that cuts coverage for weight loss penalizes patients who struggle with obesity, especially people on Medicaid who are affected by healthy eating and other resources to help lose weight.
“It’s a blind misunderstanding of the disease,” said Weber, an obesity medicine specialist in Wisconsin. “It’s a lot of money, because the drugs are expensive. But [Medicaid covers] some expensive medicines. “
Medicaid pays for more expensive drugs that treat other conditions, including cancer treatments, antivirals for hepatitis C and biologics for autoimmune disorders.
Late last year, the outgoing Biden administration proposed legislation that would have required both Medicare and Medicaid to cover FDA-approved tap treatments. In April, the Trump administration moved the legislation because it was “not appropriate at this time,” citing cost concerns. But the administration also left the door open to revisit the issue in the future.
