Does Medicaid Cover Anti-Obesity Medication?

Two-thirds of Medicaid beneficiaries have obesity or overweight, but that doesn’t necessarily mean recipients of the government-funded low income insurance program have wider access to new weight management medications.

Only 16 states list glucagon-like peptide (GLP-1) receptor agonists, a newer class of injectable medications used for both diabetes and weight loss, on their covered drug lists, according to a Fall 2023 report from health research firm KFF. The report focused on Medicaid prescriptions for Ozempic, Rybelsus, Wegovy, and Mounjaro (the latter of which is also a GIP receptor antagonist). Of these medications, only Wegovy is technically FDA-indicated for weight loss; the others are type 2 diabetes medications used “off-label” to help patients lose weight. 

“From Medicaid data publicly available, there is no way yet to disentangle how much of the growing use of these drugs is related to treatment for diabetes versus obesity, or a combination of both,” the report says.

While Medicaid is required by law to cover any Food and Drug Administration (FDA) approved drug, there’s an exception for coverage of drugs for weight management, cosmetic needs (such as wrinkles), and cough and cold medicines.

“State Medicaid programs can cover the injectable drugs, but they don’t have to,” Liz Williams, a senior policy analyst for the Program on Medicaid and the Uninsured at KFF, told Verywell.

Importantly, this is more lenient than Medicare coverage rules, which prohibit the coverage of drugs for obesity or weight loss altogether.

There’s hope that more states will add Medicaid coverage for anti-obesity medications during the current state legislative session as budgets are discussed, Kate McEvoy, executive director of the National Association of Medicaid Directors, told Verywell. 

Each state’s Medicaid website includes a formulary (a list of covered drugs) where you can check if GLP-1 medications—or other weight management drugs—are covered specifically for the indications of obesity, overweight, and/or weight loss.  

States With Coverage May Have Specific Rules

Even in states where anti-obesity medication is covered, Medicaid beneficiaries may face hurdles when procuring prescriptions. According to a report by actuarial firm Milliman, current Medicaid rules in Virginia, for example, require patients who are seeking GLP-1 medications for chronic weight management to get a letter from the doctor stating that their weight is disabling and life-threatening. They are required to have tried a drug from a different class of medication and failed to benefit from it within the past six months before getting approval to use a GLP-1.

In Michigan, Medicare authorization is contingent on a physician’s letter stating that the drug is part of a comprehensive treatment plan for weight management, including diet and exercise.

When it comes to reauthorizing GLP-1 Medicare coverage for someone already taking the medication for weight management, Mississippi, Virginia, and Michigan each require proof of weight maintenance or improvement to indicate the drug is working.

These hurdles exist because state Medicaid budgets can’t afford to cover everyone who would benefit from the drug. While some private insurers charge higher copays to help offset the cost of the drugs, Medicaid copays are capped at no more than $8 for drugs that aren’t on the preferred drug list, Wayne Turner, a senior attorney at the National Health Law Program in Washington, DC, told Verywell.

While it could be a while before all state Medicaid programs cover drugs specifically for weight loss, if a GLP-1 is approved for another indication in the meantime, Medicaid would have to cover it for that use in every state—and weight loss could be a side benefit. This recently happened with Wegovy, which earned FDA approval in March to reduce the risk of heart attack, stroke, and other cardiovascular problems in adults with heart disease who have obesity or overweight. Previously, it was only indicated for weight management.

GLP-1 manufacturers are investigating them for other uses, including sleep apnea and treatment of addiction. If the FDA approves those indications, Medicaid will cover them, Turner said.