Charleston, South Carolina - When Page Campbell's doctor advised her to try an injectable prescription drug called Wegovy lose weight She easily agreed before scheduling a bariatric surgery.

"I struggled with weight for a long time," said Campbell, a single mother, 40. "I'm not against trying anything."

Campbell said that in early April, about four weeks after she started taking Wegovy, she had no experience of any side effects, such as nausea or gut irritation. But she doesn't use the scales at home, so she says she doesn't know if she'll lose weight since her recent medical appointment since she weighed 314 pounds earlier this year. Despite this, she still has confidence in losing weight.

"It's because I'm doing the job. I'm changing my eating habits. I'm exercising. "I'm not going to guess for the second time myself." ”

Wegovy belongs to a expensive class of drugs called GLP-1 (abbreviated for glucagon-like peptide-1 agonists) that have in recent years subverted the treatment of obesity and offer hope for those who have tried and failed to lose weight in other ways.

Campbell received Wegovy through the South Carolina Medicaid decision in late 2024 to cover these weight loss pills. But for millions of patients nationwide who can benefit from it, these drugs are still out of reach, as many public and private health insurance companies consider them too expensive.

A report released by KFF in November, including health information nonprofits, found that only 13 states covered GLP-1, Medicaid beneficiaries’ obesity treatment as of August 2024.

Liz Williams, a senior policy manager for Medicaid, said she has not known she hasn't any other state Medicaid to join the list since then. Looking ahead, the rest of the states may be reluctant to add new, expensive drug benefits, and they are ready for potential federal cuts in Congress, she said.

“As the budget debate develops, it may affect states’ thinking about it,” Williams said.

The federal government will not help anytime soon. Medicare covers GLP-1 for the treatment of diabetes and other health conditions, including obstructive sleep apnea and cardiovascular disease, but is not obesity. In early April, Trump administration announces It won't finalize the rules proposed by the Biden administration, which will allow an estimated 7.4 million people covered by Medicare and Medicaid to access GLP-1 to lose weight. Meanwhile, the FDA is expected to force the market to make the cheaper, compound versions of these drugs.

Even for Medicaid patients in those states who agree to cover drugs without federal authorization, barriers to entry remain high.

Example: In South Carolina, more than one-third of all adults and nearly half of the African-American population is obese, and the state Medicaid agency estimates that only 1,300 beneficiaries will meet the strict prerequisites for GLP-1 coverage.

Under one of these requirements, Medicaid beneficiaries who want to get these drugs to lose weight must demonstrate “increased exercise activity.”

Campbell received Medicaid coverage and her body mass index was granted Wegovy coverage. First, though, she was asked to submit a six-month document that proved that she tried to lose weight after receiving a nutrition consultation and taking a 1,200-calorie diet.

Campbell's Wegovy prescription was approved for six months, Mitchell said. When that authorization expires, Campbell and her medical team will need to submit more documents, including proof that she has lost at least 5% of her weight and has been following the nutrition consultation.

“Not only, ‘sent the prescription and cover it up.’ It’s tough,” Mitchell said. “Not many people do that.”

Mitchell said the South Carolina Medicaid decision to cover these drugs is exciting among the people working in their medical professionals. But he was not surprised that the state expects relatively few people to get a relatively small number of people each year because the approval process is so strict and costly. "The problem is that the drug is so expensive," Mitchell said.

Novo Nordisk, which makes Wegovy, announced in March that the drug's monthly price has been reduced from $650 to $499 for paying customers. Mitchell said the health insurance plan and beneficiaries pay for these drugs vary, but some GLP-1s are priced over $1,000 a month, and many will need to make a lifetime to maintain weight loss.

"It's a huge price that someone has to pay the bill," Mitchell said.

That's what the North Carolina State Health Planning Commission voted last year to end GLP-1 coverage after the then North Carolina Treasury Secretary Dale Folwell's office estimated in 2023 that the drugs were expected to lose $1 billion in drugs over the next six years. The decision only comes just a few months after a separate North Carolina agency announced it would begin introducing the drugs to Medicaid beneficiaries. North Carolina Medicaid estimates it will spend $16 million a year on GLP-1.

Medicaid in South Carolina guarantees less than half of the number of people in Medicaid in North Carolina and is expected to cost less. Leieritz estimates that GLP-1 and nutrition consultations provided to South Carolina Medicaid beneficiaries will cost $10 million per year. The state fund will pay $3.3 million in fees; the rest will be paid by matching federal Medicaid funds.

In a recent interview, Secretary of Health and Human Services Robert F. Kennedy Jr.

They are “extraordinary drugs” and “we will lower costs,” Kennedy Tell CBS News In early April. He said he hopes that GLP-1 can eventually be offered to Medicare and Medicaid patients who are seeking treatment for obesity after trying other ways to lose weight. “This is the framework we are debating now.”

Meanwhile, public health experts have already praised South Carolina's decision to cover GLP-1. However, according to data released by the South Carolina Department of Public Health, the new gains don’t help the vast majority of South Carolina’s 1.5 million adults.

"We still have some work to do," admitted Brannon Traxler, chief medical officer of the Department of Public Health.

However, the state’s new “Action Plan for Healthy Eating and Active Living” was written by a group in South Carolina, which includes the Department of Public Health, without mentioning GLP-1 or their role in reducing obesity rates in the state.

Traxler said the action plan covered by a $1.5 million federal grant is not about developing an overall approach to reducing obesity in South Carolina. Instead, it promotes physical exercise, nutrition, and the expansion of outdoor walking trails, among other strategies in schools. Traxler said a more comprehensive obesity program may address the benefits of surgical intervention and GLP-1, but these programs also bring risks, expenses and side effects.

"Of course, I think it's necessary to put them together," she said.

Campbell is taking a comprehensive approach. In addition to injecting Wegovy once a week, she said she prioritized protein intake and moved her body. She also underwent bariatric surgery in late April.

“Losing weight is my biggest goal,” Campbell said. “That’s another thing that can help me achieve my goals.”

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