West Virginia patients left in limbo over changing insurance coverage of obesity meds
CHARLESTON, W.Va. — Lory Osborn says the Wegovy she was prescribed 15 months ago did more than just lose 75 pounds — more than a quarter of her body weight. The West Virginia University administrative assistant said that at age 62, she feels healthier than she has since her high school education.
But lately she’s been having panic attacks because she’s afraid she’s running out of medication. At a gross cost of $1.4 million per month, West Virginia abruptly announced in March that it would indefinitely pause a weight-loss drug pilot program for 1,000 state employees, leaving patients like them in dire straits. West Virginia’s Public Employee Insurance Agency (PEIA) will continue to cover the popular and expensive GLP-1 medications for the treatment of type 2 diabetes.
Other state and private insurers have taken a similar stance on the drugs, which can cost patients more than $1,000 a month. In 2024, Blue Cross Blue Shield of Michigan, the state’s largest nonprofit insurer, and North Carolina’s public workers’ comp insurance company stopped covering the meds for weight loss, with higher premiums said for all customers.
The dilemma comes amid a similar debate at the federal level. President Joe Biden presented a plan in November to cover medications for millions of weight-loss patients on Medicaid and Medicare, although the measure could face opposition from the newly elected administration of President Donald Trump. Robert F. Kennedy Jr., Trump’s nominee for Secretary of Health and Human Services, has criticized Ozempic — a GLP-1 used to treat diabetes.
Advocates say the long-term savings could outweigh the costs, especially in West Virginia, which has the highest rates of obesity and diabetes in the state. Obesity increases the risk of conditions such as heart disease, cancer and high blood pressure. About half of West Virginians rely on Medicare or Medicaid for insurance.
Osborn said it doesn’t make sense for West Virginia to invest the money in the pilot, only if patients would drop out and lose their progress. Osborn usually takes her shots once a week, but said she started waiting 10 to 12 days before filling her last three-month supply.
“It’s so cruel,” said Osborn, who took her last PEIA-coated dose of Wegovy weeks ago. “We suffer mentally just at the thought of going back.”
West Virginia residents are among the poorest in the US, and the state is home to rural food deserts where it can be difficult to find grocery stores, let alone one with a variety of food options.
Outgoing West Virginia Governor Jim Justice — who has lost between 30 and 50 pounds while taking Ozempic — said after Biden’s announcement that he would be “in favor of trying to do everything we can to get rid of these drugs for to make it available to everyone.”
“There’s a real argument that we end up saving that money,” said Justice, who was elected to the U.S. Senate in November. About 25% of Americans have health insurance that covers these weight-loss medications, according to the AXIACI Obesity Coverage Nexus, a database produced by the consulting firm Leverage.
The vast majority of drug coverage is provided by government health planslargely mention Medicaid plans, according to Leverage. All state Medicaid programs cover medications for type 2 diabetes, but only 14 provide any coverage for obesity treatment. Medicare plans cover the weight loss medications if they are prescribed to someone at risk for stroke or heart disease.
Dr. Laura Davisson, director of medical weight management at West Virginia University said losing drug coverage is a “nightmare” for patients. This year, Davisson’s office saw more than 1,000 GLP-1 patients — many of whom made additional appointments or joined support groups with her staff to discuss options when they learned of the coverage changes.
“We are the state with the highest obesity rate, and I have just lost all access to my most powerful tool for the medical treatment of obesity across almost all of my payers,” she said. “How does that make sense?”
The length of time she sees patients take the medication varies, but some may need to take it indefinitely to suppress food cravings. She said the pilot program for state employees took a responsible approach by requiring patients to be prescribed the drugs through obesity specialists, with advice on diet, exercise and managing side effects.
“They’ve already invested millions of dollars in these people,” she said. “It’s financially wasteful to throw it away, let these people put the weight back on, have their health problems come back, and we don’t really get to see the full potential of these people. this pilot project.”
Dr. Bisher Mustafa of the Marshall Health Obesity Clinic in Huntington said there is a certain irony in waiting until people have diabetes before starting the medication.
“The idea is to try to prevent diabetes from the start,” he said.
PEIA Director Brian Cunningham said GLP-1s, which the state began offering for weight loss in 2019, cost the program about $53 million last fiscal year — about 20% of what PEIA spends on drugs.
The cost of the GLP-1s was cited as the reason for premium increases of 14% for state employees, as well as a 16% increase for county employees and a 12% increase in costs for retirees. The increases will come into effect in July, according to the insurance company, which covers 150,000 government employees, 56,000 retirees and their dependents.
That frustrates some PEIA members who feel they are unfairly bearing the costs for a drug they don’t use. Ashley Peggs, a Kanawha County teacher who does not take GLP-1 medications, said her heart sank when she saw how much the plan spent on the drugs during a public hearing on the proposed premium increases.
She said the agency had just denied coverage for a spinal procedure due to a condition that threatens her ability to walk.
“So the fact that someone else is thin is more important than the fact that I literally might not be able to teach again until I retire without a wheelchair?” Peggs, 35, said at the public hearing.
Some who were taking the diabetes medications — like the vast majority of state employees on GLP-1s — expressed frustration that they haven’t even been able to access Ozempic consistently because of the shortages.
“What will be cheaper: paying for that medicine or losing a leg to gangrene, like my grandmother did?” said Michael Kimball, 42, who takes the drug for diabetes. “Year after year the burden is placed on the backs of working people and we are getting a little tired of it.”
Osborn described Wegovy as a breakthrough recommended by her provider after years of trying to lose weight any way she could. She has also been able to halve the amount of rheumatoid arthritis medication she takes and has seen back pain and her sciatica almost eradicated.
She said cutting coverage for obesity patients feels like “discrimination based on weight” because other chronic diseases qualify. Osborn said she will try to purchase versions of the drugs that are not FDA-approved through compounding pharmacies. Doing so will increase her costs to about $300 per month. PEIA had given her a three-month supply for $50.
“I think they need to realize that obesity is a disease – it is not a willpower, a choice that you have to eradicate,” she said. “It’s a disease you suffer from, just like any other disease you can’t prevent.”