Medi-Cal to end coverage for weight-loss drugs

Many low-income Californians prescribed wildly popular weight-loss drugs will lose their coverage for the medications in the new year.

- BY DON THOMPSON

Health officials are recommending diet and exercise as alternatives to heavily advertised weight-loss drugs like Wegovy and Zepbound, advice that 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 two years using GLP-1s covered by Medi-Cal, California’s version of Medicaid.

California is joining 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 “dramatically lower cost to taxpayers” for the drugs and enable Medicaid to cover "It will be quite negative for our patients" because data show people typically regain weight after stopping the drugs, said Diana Thiara, medical director of the UC San Francisco Weight Management Program.

Although California and New Hampshire will not cover GLP-1 prescriptions for obesity beginning Jan. 1, they will continue to cover the drugs for other health issues, such as type 2 diabetes, cardiovascular disease and chronic kidney disease.

Michigan, Pennsylvania, Rhode Island, South Carolina and Wisconsin are planning or considering restrictions, according to the Kaiser Family Foundation's most recent survey of state Medicaid programs.

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, probably because of 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.