Coverage for weight loss medications varies as per state under Medicaid. While some states allow the coverage of certain relevant medications, others do not cover any medications at all. In general, Medicaid is more inclined to cover weight loss medications when they are prescribed for other health conditions, such as diabetes or high blood pressure.
Some examples of weight loss medications that may be available through Medicaid are as follows:
- Orlistat (Xenical): This medication blocks a portion of the fat you eat from being absorbed into your body. It is available as a prescription and an over-the-counter medication.
- Phentermine-topiramate extended-release (Qsymia): A weight loss medicine made from the combination of two different medicines.
- Naltrexone-bupropion extended-release (Contrave): Weight loss medicine that combines two medicines.
- Liraglutide (Saxenda): A GLP-1 receptor agonist that mimics a hormone that controls appetite and blood sugar levels.
- Semaglutide (Wegovy, Ozempic): Another GLP-1 receptor agonist for weight control and blood sugar management.
Important Considerations:
- State-Specific Coverage: Given that every state’s Medicaid coverage regulations differ, checking with your particular state’s Medicaid program is advised in order to know about the medicines covered and under what conditions.
- Underlying Health Conditions: Medicaid will be much more likely to cover such weight loss medications if they are prescribed for another health condition, such as obesity, diabetes, or high blood pressure.
- Prior Authorization: Some state Medicaid programs may require prior authorization for certain medicines in order to be reimbursed.
- Income and Eligibility: Medicaid coverage and eligibility vary with the income and other parameters.
How to Determine Coverage:
Medicaid coverage for weight loss medications can vary so much by state. While some states may cover some, others may not cover any. It is generally more likely that Medicaid will cover weight-loss medications when they are prescribed for a related health condition such as diabetes or high blood pressure.
Here are some treatments for weight loss that Medicaid may consider under certain circumstances:
- Orlistat (Xenical): The medication prevents fat from being absorbed by the body. Available only via prescription and some over-the-counter formulations.
- Phentermine-topiramate extended-release (Qsymia): The activity combines two medications to help weight loss.
- Naltrexone-bupropion extended-release (Contrave): The activity combines two medications to assist in weight loss.
- Liraglutide (Saxenda): This medication acts as a GLP-1 receptor agonist mimicking a hormone that regulates appetite and blood sugar levels.
- Semaglutide (Wegovy, Ozempic): Another GLP-1 receptor agonist aiding weight loss while supporting blood sugar control.
Things to Keep in Consideration:
- State-Specific Coverage: The coverage rules and regulations of Medicaid vary across states. It is very important to check with the specific state Medicaid program for medications covered under their condition.
- Underlying Medical Conditions:- Medicaid is more likely to cover weight loss medications prescribed for a related health condition such as obesity, diabetes, and hypertension.
- Prior Authorization: Coverage for some medications may require prior authorization by your state Medicaid program.
- Income and Eligibility: Medicaid approval changes with regard to income and other related conditions.
