CHARLESTON, W.Va. — Lory Osborn shares her experience with Wegovy, a medication she was prescribed a year and a half ago that helped her shed 75 pounds, or over 25% of her body weight. Now at 62 years old, she feels healthier than she has in decades. However, she’s recently been dealing with panic attacks triggered by the anxiety of potentially running out of her medication. This concern was heightened when West Virginia abruptly declared in March a halt to a pilot program that had been covering weight loss medications for public employees, citing exorbitant monthly costs totaling around $1.4 million. While the state’s Public Employee Insurance Agency (PEIA) will still fund the highly sought-after GLP-1 medications for Type 2 diabetes, those aiming for weight loss are left in distressing uncertainty.
Simultaneously, other state and private insurance providers are reassessing their positions on these medications. For instance, in 2024, major insurers such as Blue Cross Blue Shield of Michigan and North Carolina’s public employee health coverage ceased to offer weight loss drug coverage, attributing the decision to premium increases for all customers. This issue is part of a broader national discussion, as President Biden introduced a plan last November aimed at including these drugs under coverage for weight loss among Medicaid and Medicare beneficiaries. However, there is speculation that this initiative may encounter obstacles under a potential administration led by President-elect Donald Trump, particularly with Robert F. Kennedy Jr. — Trump’s pick for Health and Human Services Secretary — openly opposing medication like Ozempic, commonly used for diabetes.
Advocates argue that investing in weight loss treatments could eventually lead to overall cost savings, particularly in West Virginia, which has some of the highest obesity and diabetes rates in the nation. The health risks linked to obesity include heart disease, cancer, and high blood pressure. Approximately 50% of West Virginians depend on Medicare or Medicaid for their healthcare coverage. Osborn emphasized that it feels illogical for the state to halt its investment in this pilot program, especially when doing so risks undoing the progress patients have made. Traditionally, she administered her injections weekly but has started stretching her doses to make her three-month supply last longer.
“This situation is heartbreaking,” remarked Osborn, who recently finished her last dose covered by PEIA. “We’re struggling mentally just thinking about reverting to our previous circumstances.” The struggle is magnified by West Virginia’s economic struggles, as numerous residents live in poverty and face significant challenges accessing nutritious food in rural areas.
Outgoing Governor Jim Justice of West Virginia, who has himself lost significant weight on Ozempic, expressed support for making these medications accessible to all following Biden’s announcement. “There’s a solid case that in the long run, we could save money through this investment,” stated Justice, who recently secured a U.S. Senate seat. According to a database from the Leverage consulting firm, only about 25% of Americans currently have health plans that cover weight loss medications.
The trend shows that most coverage for such medications comes from government health plans, especially state Medicaid programs. While all state Medicaid plans cover GLP-1 drugs for treating Type 2 diabetes, only 14 states cover them for obesity treatment. Additionally, Medicare only covers these medications for weight loss under specific conditions, such as being prescribed to those at elevated risk for heart disease or stroke.
Dr. Laura Davisson, who leads the medical weight management program at West Virginia University, described the loss of medication coverage as a “nightmare” for her patients. This year alone, her office has seen over 1,000 patients using GLP-1 medications, with many requiring additional support and consultations as a result of the coverage changes. “Given that we have the highest rate of obesity in the nation, losing access to the best tools for treating this condition is baffling,” she expressed.
The duration patients need to stay on these medications can vary significantly; some might need lifelong treatment to keep appetites in check. She noted that the state employee pilot program had implemented a well-structured approach, allowing prescriptions from obesity specialists along with guidance on dietary changes, exercise, and managing potential side effects. “They already invested millions in these individuals. It’s financially irresponsible to abandon this investment and let them regain weight, leading to recurring health issues without seeing the pilot program’s full potential,” she commented.
Dr. Bisher Mustafa, affiliated with the Marshall Health Obesity Clinic in Huntington, highlighted the irony of only providing treatments once diabetes emerges, rather than focusing on prevention from the start. PEIA Director Brian Cunningham reported that the inclusion of GLP-1 medications since 2019 has cost the program around $53 million for the last fiscal year, accounting for 20% of total drug expenditures.
These high costs have contributed to premium increases: 14% for state employees and 12-16% for county workers and retirees, set to take effect in July. Such increases have sparked frustration among PEIA members, with some feeling resentful about funding medications they do not use. Ashley Peggs, a teacher from Kanawha County, expressed her disappointment when hearing about the spending on these drugs during a public hearing about the premium hikes. Having recently been denied coverage for a crucial spinal procedure, Peggs lamented, “Shouldn’t my ability to walk take precedence over someone else’s weight loss?”
Many employees reliant on GLP-1 drugs for diabetes treatment have also faced difficulties, often unable to access medications consistently due to shortages. “Would it be cheaper to fund this medication, or for me to face severe consequences like losing a leg due to complications?” questioned Michael Kimball, who is 42 and uses the medication for diabetes. “Year after year, the financial burden increasingly falls on the working class, and we’re becoming frustrated with it.”
Osborn described Wegovy as a significant breakthrough that was recommended by her provider after years of unsuccessful weight loss attempts. The medication has allowed her to reduce her rheumatoid arthritis medication intake and alleviate her back pain and sciatica issues. She perceives the decision to cut coverage for obesity treatments as “weight-based discrimination,” especially since other chronic conditions continue to receive coverage. With coverage from PEIA previously providing her a three-month supply of the medication for $50, she now considers sourcing unapproved versions from compounding pharmacies, which could cost her about $300 monthly.
“It’s crucial for everyone to recognize that obesity is a disease — it’s not solely a matter of willpower or determination,” she asserted. “It’s a medical condition, deserving of the same recognition and treatment as any other chronic health issue.”
