California Ends Medicaid Coverage of Weight Loss Drugs

Many low-income Californians prescribed wildly popular weight loss drugs lost their coverage for the medications at the start of the new year.

Health officials are recommending diet and exercise as alternatives to heavily advertised weight loss drugs like Wegovy and Zepbound, advice experts say is unrealistic.

“Of course he tried eating well and everything, but now with the medications, it’s better — a 100% change,” said Wilmer Cardenas of Santa Clara, who said his husband lost about 100 pounds over about two years using GLP-1s covered by Medi-Cal, California’s version of Medicaid.

California joined several other states in restricting an option they say is no longer affordable as they confront soaring pharmaceutical costs and steep Medicaid cuts under the Trump administration, among other financial pressures. Despite negotiated price reductions announced in November that the White House said would make the drugs available at a “dramatically lower cost to taxpayers” and enable Medicaid to cover them, states are going ahead with the cuts, which providers say may undermine patients’ health.

“It will be quite negative for our patients” because data shows people typically regain weight after stopping the drugs, said Diana Thiara, medical director of the UC San Francisco Weight Management Program.

While California, New Hampshire, Pennsylvania and South Carolina stopped covering adult GLP-1 prescriptions for obesity on Jan. 1, they continue to cover the drugs for other health issues, such as Type 2 diabetes, cardiovascular disease and chronic kidney disease.

Michigan, Rhode Island and Wisconsin are planning or considering restrictions, according to KFF’s most recent survey.

freestar That reverses a trend that saw 16 states covering the medications for obesity as of Oct. 1. Interest in providing the coverage “appears to be waning,” the survey found, likely due to the drugs’ cost and other state budget pressures. North Carolina pulled back GLP-1 coverage in October, but Gov. Josh Stein reinstated it in December, bowing to court orders despite a lingering budget shortfall.

Catherine Ferguson, vice president of federal advocacy for the American Diabetes Association and its affiliated Obesity Association, said it’s not clear how states will adjust to the White House plan to lower the cost of several of the most popular GLP-1s through TrumpRx, an online portal for discounted prescription drugs. The price of Wegovy, for example, will be $350 per month for consumers, versus the current list price of nearly $1,350, and Medicare and Medicaid programs will pay $245, according to the plan.

“Many states are facing budgetary challenges, such as deficits, and are working to address the impacts of the changes to Medicaid and SNAP,” Ferguson wrote, referring to the Supplemental Nutrition Assistance Program. “As more details become available for the Administration’s agreements, we will see how state Medicaid responds.”

The Department of Health and Human Services referred questions to the White House, which did not respond to requests for comment on states’ termination of Medicaid coverage for the weight loss drugs.

California projected its costs to cover GLP-1s for weight loss would have more than quadrupled over four years to nearly $800 million annually if it didn’t end Medi-Cal coverage for that use. Medi-Cal has covered weight loss drugs since 2006, but use of GLP-1s soared only in recent years. By 2024, more than 645,000 prescriptions were covered by Medi-Cal across all uses of the medications. The California Department of Health Care Services could not readily provide a breakdown of whether the drugs were for weight loss or other conditions.

When asked whether the state would reconsider its plans in light of the announced price cuts, Department of Finance spokesperson H.D. Palmer said it had no plans to do so. California’s cut is written into the state’s budget law.

California officials would not say how much it could save under the TrumpRx plan, citing federal and state restrictions on disclosing rebate information.

Health providers don’t expect the Trump administration’s negotiated price cuts to make much difference to consumers, because pharmaceutical companies already offer some discounts.

“The out-of-pocket costs will still be very cost-prohibitive for most, especially individuals with Medicaid insurance,” Thiara said.

New Hampshire is among the other states that ended their coverage Jan. 1. Officials with the New Hampshire Department of Health and Human Services did not respond to requests for comment.

About 1 in 8 adults are now taking a GLP-1 drug for obesity, disease or both, up 6 percentage points from May 2024, according to KFF poll results released in November. Over half of users said their GLP-1s were difficult to afford, and many who had stopped the treatment cited the cost.

Public and private payers have been trying to wean patients off to save costs. California health officials said Medi-Cal members and their health care providers should consider “other treatment options that can support weight loss, such as diet changes, increased activity or exercise, and counseling.” That echoes advice from the New Hampshire Medicaid program.

California Department of Health Care Services spokesperson Tessa Outhyse said in an email that the official advice to try those other approaches now “is not meant to dismiss any past efforts, but to encourage Medi-Cal members to take a renewed, proactive, and medically supported approach with their healthcare provider that may appropriately include these additional options.”

But that may be unrealistic, said Kurt Hong, founding director of the Center for Clinical Nutrition at USC’s Keck School of Medicine.

“We definitely want patients to do their part with the diet and exercise, but unfortunately, and from a practical standpoint, that itself frequently is not enough,” Hong said, adding that usually by the time patients see doctors they have already failed at achieving results through those means.

Hong understands why Medicaid programs, as well as private providers, want to cut back on covering the drugs, which can cost thousands of dollars per patient per year. However, they can produce twice the weight loss as the medications typically used previously, he said.

There has got to be a balance somewhere.
What is the cost of medical care avoided due to weight loss?
What is the cost of side effects of the drugs.

“low-income Californians prescribed wildly popular weight loss drugs”

Only in America are poor folks so fat they need weight loss drugs. Your taxes are paying to fatten em up AND to slim em down.

FWIW-
In addition, Obesity, Insulin Resistance, and Diabetes are a huge problem for our Latino fellow Citizens. The America Diet wrecks havoc on them. More outreach to folks to get the word out . . .
Illegals? GTFO.
Fellow Citizens? We love you, take better care of yourselves and your families! You’re part of helping to MAGA.
Todays Tamales ain’t yer Abuelas Tamales.
GMO Corn and Sugar is killing people.

FWIW-
Black folks too.

There has got to be a balance somewhere.

I agree. I don’t know how to balance cost vs benefit.
What if some year down the road, a drug or other treatment would 100% prevent cancers and heart problems for life…but it COSTS the drug manufacturers $3,500,000 per patient. How can you pin down at what point you forget about it.

People could eat soup.

Healthy soups are easy to make and cheap.

If your stomach gets filled with mainly water there will be fewer calories one can consume in a day.

“Who said HIS husband lost 100 pounds”. But you still were doing the butt dance when he was grossly overweight so......... sounds like another graft situation

data shows people typically regain weight after stopping the drugs

They should learn to eat less and exercise more. It’s not a complicated formula.

I was obese most of my adult life, until I hit my mid-60s and decided I would like to live long enough to see my grandkids grow up.

I lost over 100 lbs. in a year and a half simply by walking an hour every morning and cutting out most sugar and processed foods. Every chronic health problem that I had dropped away with the pounds. I continue to watch what I eat, walk an hour every day, added strength training 3 days a week, and have kept it off for over a year now.

If an old fat man can do it, anyone can.

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