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The injectable drug\u00a0Ozempic is pictured in July 2023. Texas Medicaid excludes anti-obesity medications such as GLP-1s and other weight-loss drugs, our guest columnist writes.<\/p>\n
David J. Phillip\/AP<\/p>\n
Several overlooked factors can affect progress as people trying to lose weight battle their bodies. Expanding Medicaid in Texas to cover weight-loss prescription drugs is about increasing medically appropriate options, not selling a silver bullet, our guest columnist writes.<\/p>\n
None\/Hearst Newspapers<\/p>\n
Every week, I see the same group of people walk into our clinic and step on the same scale.<\/p>\n
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Maria, 67, who is retired and has a Medicare card, steps on a scale and reads body mass index of 36. She leaves with a prescription and a plan.<\/p>\n
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Two days later Ana, 44, steps on the same scale. Her\u00a0BMI is also 36, and her A1c is creeping up. She tells me the same fears Maria did. I told Ana what I tell everyone: Eat less. Move more.<\/p>\n
I did not tell her there is a drug that could help, because unlike Maria, Ana cannot get that drug if it was prescribed for her.<\/p>\n
Texas Medicaid categorically excludes anti-obesity medications<\/a> like GLP-1s and other weight-loss drugs, such as semaglutide (Wegovy), tirzepatide (Zepbound), orlistat and older agents.<\/p>\n This is not a prior-authorization hurdle. It is an explicit exclusion the state has chosen under federal rules.<\/p>\n Article continues below this ad<\/p>\n A 44-year-old on Medicaid who needs medication for obesity and diabetes prevention is not being denied after review. She was never in the queue.<\/p>\n Nearly 17% of\u00a0Bexar County adults have diagnosed diabetes, higher than the state and national percentages, and our county\u2019s diabetes mortality is about 33 deaths per 100,000, above Texas and U.S. rates.<\/p>\n Roughly 72% of adults<\/a> here are overweight or obese, and more than a quarter of people with diabetes earn under $25,000 a year.<\/p>\n Those numbers mean the policy gap is concentrated harm in neighborhoods already struggling with food insecurity and limited access to care.<\/p>\n Article continues below this ad<\/p>\n It took me years to admit this. When I told patients that losing weight took discipline, I lied, because, quite frankly, when it came down to it, I didn\u2019t believe them when they told me that they tried but failed.<\/p>\n I blamed their willpower instead of acknowledging the real reason they were unable to lose weight: The system is against them.<\/p>\n These medications are not miracle cures. GLP-1s reduce appetite and produce real weight loss while taken, and for some patients they lower the risk of developing diabetes.<\/p>\n They carry side effects and are not appropriate for everyone.<\/p>\n Article continues below this ad<\/p>\n They also carry a price tag, with starter doses often costing hundreds of dollars a month, in a county where many patients live on very little. I prescribe these drugs when clinically appropriate. I also tell patients when they are not right for them.<\/p>\n This is about expanding medically appropriate options, not selling a silver bullet.<\/p>\n The federal window has already closed for now.<\/p>\n The Centers for Medicare and Medicaid Services accepted applications from state Medicaid agencies for its Better Approaches to Lifestyle and Nutrition for Comprehensive Health<\/a> model through July 31, and states that applied can begin on a date of their choosing any time up to Jan. 1, 2027. States that did not apply can join after that only at the agency\u2019s discretion.<\/p>\n Article continues below this ad<\/p>\n Where Texas stands remains unclear.<\/p>\n Opting in would not fix every inequity, but it would be a start.<\/p>\n The next time I weigh Ana on the scale, I wish I had more to offer her than \u201cjust try harder.\u201d Her words after our visit were, \u201cSo I just keep trying alone?\u201d<\/p>\n I have no answer for her right now.<\/p>\n Article continues below this ad<\/p>\n Dr. Shiv Kumar\u00a0Goel is an internal medicine and functional medicine physician in San Antonio and founder of Prime Vitality Care.<\/p>\n