Obesity Crisis: A Policy Challenge

Despite Mississippi’s groundbreaking decision to cover GLP-1 weight loss drugs through Medicaid, an unexpectedly low uptake reveals a tangled web of barriers and missed opportunities.

Story Snapshot

  • Mississippi covers GLP-1 weight loss drugs through Medicaid since 2023.
  • Only 2% of eligible adults have prescriptions as of December 2024.
  • Barriers include drug shortages, strict authorizations, and lack of awareness.
  • Mississippi has one of the highest obesity rates in the U.S.

Mississippi’s Bold Step and Unexpected Challenge

In 2023, Mississippi made a bold move by deciding to cover GLP-1 weight loss drugs under Medicaid for individuals aged 12 and older. This decision, however, has not translated into widespread use, with only about 2% of eligible adults receiving prescriptions by December 2024. This scenario unfolds in a state grappling with one of the highest obesity rates in the U.S., where the policy was expected to significantly alter the public health landscape.

Several factors contribute to this underwhelming uptake. Drug shortages have been a major hurdle, alongside stringent prior authorization requirements that complicate access. Additionally, a lack of awareness among both healthcare providers and potential beneficiaries has stymied the policy’s impact. These challenges are particularly disheartening given the initial optimism surrounding the coverage decision.

Background and Broader Context

GLP-1 drugs, initially developed for diabetes, have proven highly effective for weight loss. Despite FDA approval for chronic weight management, the high costs have deterred many states from covering them under Medicaid. Mississippi, however, saw potential in addressing its soaring obesity rates, which affect about 40% of adults. The state was one of only 13 to offer this coverage, positioning itself as a potential model for others.

Mississippi’s Medicaid program, known for its strict eligibility criteria and limited benefits, faced high expectations to alleviate a pressing health issue. Yet, this ambition has collided with the harsh realities of supply constraints and administrative red tape, significantly hindering progress.

Stakeholders and Their Roles

The key players in this unfolding story include the Mississippi Division of Medicaid, tasked with policy implementation and managing prior authorization processes. Medicaid enrollees, particularly those battling obesity and related health issues, rely on this coverage for access to treatment. Healthcare providers, who prescribe and manage GLP-1 therapy, face administrative challenges. Pharmaceutical manufacturers, meanwhile, grapple with supply shortages that exacerbate access issues.

Within this ecosystem, Medicaid holds significant decision-making power over coverage and utilization, while providers often act as gatekeepers, limited by policy and availability constraints. Enrollees, meanwhile, remain at the mercy of these dynamics, dependent on provider advocacy to navigate the system effectively.

Current Developments and Efforts

Recent data from December 2024 highlights the continued struggle to increase utilization, with only 2,900 enrollees beginning treatment in 15 months, primarily outside the highest-need areas like the Mississippi Delta. During this period, Medicaid spent $12 million on the program, benefiting about 2,200 adult members. Efforts to raise provider awareness persist, but no substantial outreach initiatives have emerged to address the low uptake.

Despite these challenges, the state recently updated its coverage criteria and drug lists in February 2025, signaling ongoing attempts to refine and possibly enhance the policy’s effectiveness. However, without addressing fundamental barriers like drug shortages and awareness gaps, these updates may have limited impact.

Analysis of Impacts and Future Prospects

The short-term implications of this scenario are clear: limited access to effective weight loss treatments for Mississippi’s Medicaid enrollees, particularly in regions with the greatest need. While there have been modest health improvements for a small group of beneficiaries, systemic barriers continue to impede broader success. Providers face ongoing administrative burdens, limiting their ability to offer evidence-based care.

In the long term, if utilization increases and obesity-related health complications decrease, there is potential for significant cost savings. However, if costs rise without measurable health improvements, the policy could face scrutiny or even reversal. Mississippi’s experience could inform other states with high obesity rates, provided these barriers are effectively addressed.

Sources:

KFF Health News
KFF.org
GoodRx
Mississippi Division of Medicaid
Mississippi Division of Medicaid
Mississippi Division of Medicaid

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