States Are Walking Back Medicaid Coverage for GLP-1s

[BooneDonk]

There is a huge group that has been pushing for the defunding of Glp-1 medications by insurance companies and it’s not who you would think it is. They do not want their main source of “revenue” to be taken from them. Believe it or not, it’s the surgical community that takes care of the bariatric patients. Glp’s have taken a lot of their patients from them. Which has hit hospitals and surgical centers in their pockets BIG time. If you lose your weight with S/T/R or whatever combo…..would you still qualify for weight loss surgery? No. Think of all the patients who have turned to Glp’s for that 6month pre surgical weight loss program that has to be done prior and found success and didn’t need surgery. I work in the medical field and I’ve seen how hard it’s hit and they are pissed! But I’ve seen too many lives ruined by weight loss surgery and it’s about time there truly was another/better option! IMO

The list of people I know that have had bariatric surgery and have not had divorce, drinking/drug problems, and/or weight regains is very short. I can definitely see the hospitals lobbying against GLP’s. Trying to keep the coffers full!!

 

[LuckyLukey]

There is a huge group that has been pushing for the defunding of Glp-1 medications by insurance companies and it’s not who you would think it is. They do not want their main source of “revenue” to be taken from them. Believe it or not, it’s the surgical community that takes care of the bariatric patients. Glp’s have taken a lot of their patients from them. Which has hit hospitals and surgical centers in their pockets BIG time. If you lose your weight with S/T/R or whatever combo…..would you still qualify for weight loss surgery? No. Think of all the patients who have turned to Glp’s for that 6month pre surgical weight loss program that has to be done prior and found success and didn’t need surgery. I work in the medical field and I’ve seen how hard it’s hit and they are pissed! But I’ve seen too many lives ruined by weight loss surgery and it’s about time there truly was another/better option! IMO

I shouldn’t be surprised by this but I am. I know a couple people who are having significant malnourishment issues after weight loss surgery. I am rather disenchanted with allopathic medicine and am lucky enough to afford to see a functional practitioner.

Still stewing…..What happened to the hypocritical oath? These doctors can move in to other sectors of medicine, should their sectors be obsolete by GLP1, can they not?

 

[yobculture]

When I was young, and my parents got divorced, my mom was on her own with four kids. She was uneducated and didn’t have a job. So we moved into subsidized housing, had to use food stamps in order to eat, and I got teased by my classmates because I was getting free lunch at my school. During this period, my mom plowed through college getting her BA and Masters in a very short period of time. Without the aid we received, we would have been fucked.

My mom got an incredible job at a major university. She happily paid taxes until she died at the age of 89. On top of that, she was a massive donor to various causes. She has given back way more than she had ever received. And she had four fairly successful children who also became taxpayers who given back to the community.

Systems are set up for situations like my mom’s. It’s horrifying and sad to read really thoughtless (and offensive) generalizations and stereotypes about those who are less privileged. I cannot imagine not wanting to help those in need.

I actually envy those who don’t care about other people and their health and welfare. Shaming them and calling them “fat.” Yikes. It must be an easy life to be so coarse and uncaring. The good news for them is that things are changing rapidly for the worse: The government is reducing federal Medicaid spending by $793 billion. Countless people will be without healthcare and will likely die. Something to celebrate! Freeloaders, right?

I believe in helping people out whether I receive anything in return or not. Why on earth do people always feel the need for a return? Isn’t being kind enough? If my taxes go toward helping rebuild their lives and get healthier, then I support that 100%. The article made me incredibly sad because there are so many people who are less privileged whose lives would change drastically if they had access to GLP-1s. And, yes, the price is high but that’s Eli Lilly’s fault, not the fault of those who would benefit from GLP-1s.

 

[latviantower]

And just a friendly reminder folks to please walk the fine line regarding political discussion carefully. This is one of those issues that I think are important to discuss in regard to GLP-1s and the benefits they offer to society, but still requires a fair amount of self-discipline to avoid becoming a political discussion/debate.

Well stated. And it took me a second read to appreciate the irony of the use of the term “self-discipline” in this forum.

 

[keangkong]

GLPs for obesity are optional. I don’t want to pay for other people to be on these drugs when I’m already paying for myself to be on them.

I don’t mind paying for people who are receiving governmental assistance to receive GlP-1 drugs. That is if the government buys them from Chinese vendors like I do.

 

[keangkong]

The list of people I know that have had bariatric surgery and have not had divorce, drinking/drug problems, and/or weight regains is very short. I can definitely see the hospitals lobbying against GLP’s. Trying to keep the coffers full!!

I’d be surprised if bariatric surgeons have much of a lobby.

 

[byefatlicia]

I’d be surprised if bariatric surgeons have much of a lobby.

I sat in one before. It was pretty nice

 

[MsGizmo]

GLPs for obesity are optional. I don’t want to pay for other people to be on these drugs when I’m already paying for myself to be on them.

That is very short sighted. There are many reasons that I think Medicaid should cover obesity medication.

#1 - Losing weight will help them in the job market, getting them off benefits or at least reducing them.

#2 - You never know what tomorrow will bring, it could be you or a loved one that ends up needing coverage.

#3 - If Medicaid covers something, private insurance companies often follow.

#4 - Medicaid/Medicare coverage would enable the government to apply pressure to lower the costs (yes, I know this one is a long shot)

#5 - Medicaid/Medicare covers bariatric surgeries. I know this for a fact because when I attended the weekly support group when I had my surgery about half of the people there had Medicaid. My surgery cost right around $14000 in 2016. I don't know what Medicaid paid for the surgeries .. but the entire support group was from the same clinic as me, I doubt they got a discount. Heck, for all I know Medicaid could have paid more. $14000 would give an obese person at least 2 years of retail GLP-1.

 

[MsGizmo]

If they are on Medicaid it’s a pretty safe assumption that our taxes are probably paying to make the same people fat by allowing them to make poor choices and buy ultra processed foods and sugary beverages with food stamps. So, you are also happy to be hurting/enabling them?

No. Its not safe to assume any such thing. People on food stamps buy the same food products as everyone else.

 

[MsGizmo]

Think of all the patients who have turned to Glp’s for that 6month pre surgical weight loss program that has to be done prior and found success and didn’t need surgery.

No kidding. If I had a $1k a month shot available to me in 2016 instead of spending $14k on a surgery. Well, I know what I would have chosen at the time. Back then I wouldn't have even needed the grey market.

 

[MsGizmo]

I sat in one before. It was pretty nice

They have big chairs.

 

[pavlovs]

Wish I could agree with you. I can’t tell you how many times I’ve been to the grocery store and seen people piling junk food on the conveyor and then paying with EBT. It’s easy to waste when it’s not your money. Meanwhile, I am budgeting and buying the healthiest food I can afford because I’m overtaxed.

My cousin was one of those people throwing junk up on the conveyer belt. Someone heckled her when she paid with her card (years ago). She'd quit a high paying job to care her child who had leukemia. The heckler never knew that the junk she was buying was for what turned out to be her daughter's last birthday party. I'm glad people have been able to make their own choices regarding the foods they pick. For some people, that is the only control they have in their entire life, and for others, food may be the only joy they have in their lives.

 

[Jfrick11]

Wish I could agree with you. I can’t tell you how many times I’ve been to the grocery store and seen people piling junk food on the conveyor and then paying with EBT. It’s easy to waste when it’s not your money. Meanwhile, I am budgeting and buying the healthiest food I can afford because I’m overtaxed.

I get that it can be frustrating to see purchases you wouldn’t make yourself, but a checkout snapshot doesn’t tell the whole story of someone’s life or budget. SNAP benefits are limited and often don’t stretch to cover a full month’s food, and the cheapest calories in our system are usually the least healthy—because subsidies and pricing favor processed food over fresh produce. Also, most people on assistance are working, paying taxes, or are children, seniors, or disabled. If we want to reduce both costs and poor health outcomes, reforming the food system and making healthy options affordable would go a lot further than assuming waste just because the payment card says EBT.

 

[GLP1Pharmacist]

GLPs for obesity are optional. I don’t want to pay for other people to be on these drugs when I’m already paying for myself to be on them.

But the same health plan will pay $571,000 for a bladder cancer drug that likely won't change outcome by months.

Regarding obesity, you are paying one way or another, when they enter the healthcare system, ER and other medical costs.

 

[Morbius]

But I’ve seen too many lives ruined by weight loss surgery

I have found it interesting to read the places on Reddit where medical pros talk amongst themselves. When the topic of "what kind of procedure should people really, really avoid if they can?" comes up the highly upvoted answers always include spinal and bariatric surgery.

Still stewing…..What happened to the hypocritical oath?

Docs are like anyone else, you get into power and it can change you. The fact that our system is completely f'ed up and expenses are out of control give docs a lot of extra power they ideally should not have, because you cannot switch docs like you can switch accountants. You could be stuck with Dr. Nick due to the kind of coverage you have. Your doc could be great, but their hands could be tied by insurance which can push them into burnout and compassion fatigue. The broken system helps to bring out the worst in anyone in that system.

Not that I have had terrible experiences with docs myself... I genuinely don't have a really bad view of docs in general --yet--but when you find a dismissive, disinterested, or power-trippin' doc the reasons seem easy to understand.

 

[MillyFanilly]

I can’t help but be pissed when someone who has Medicaid get their GLP1 paid for when I pay for my insurance and have paid out of pocket for the last two years. I know I shouldn’t feel that way but I can’t help it. I’ve spent a ton of money bettering my health and my life. I know it’s a matter of employer and insurance but nothing makes me feel any better about it.

 

[AndyPanda]

I shouldn’t be surprised by this but I am. I know a couple people who are having significant malnourishment issues after weight loss surgery. I am rather disenchanted with allopathic medicine and am lucky enough to afford to see a functional practitioner.

Still stewing…..What happened to the hypocritical oath? These doctors can move in to other sectors of medicine, should their sectors be obsolete by GLP1, can they not?

Doctors are great for broken bones, but they are more fallible than people generally give them credit for. Medical errors are the third leading cause of death in the United States. The fact that statistic exists is mind blowing. They just want their money like everyone else. What other job could someone get away with being wrong that much, other than a meteorologist?

I know there are good ones out there before the naysayers come after me again.

 

[mlke6]

I have found it interesting to read the places on Reddit where medical pros talk amongst themselves. When the topic of "what kind of procedure should people really, really avoid if they can?" comes up the highly upvoted answers always include spinal and bariatric surgery.

What's the usual response over never getting bariatric surgery?

 

[pavlovs]

Doctors are great for broken bones, but they are more fallible than people generally give them credit for. Medical errors are the third leading cause of death in the United States. The fact that statistic exists is mind blowing. They just want their money like everyone else. What other job could someone get away with being wrong that much, other than a meteorologist?

I know there are good ones out there before the naysayers come after me again.

A friend and I were talking about this just yesterday. I diagnose and treat mental health disorders, and yup, we are wrong a LOT. I think that AI is going to do a lot to help in the diagnostic field. Some of the medical providers I work with are beta testing a program now that has already shown to be 75 times more likely to get the correct diagnosis compared to a doctor when both are fed the exact amount of information.

I am longing for the day, to be honest. One of the worst feelings in the world is to misdiagnose someone and cause months and years more suffering than there needed to be.

 

[MsGizmo]

I can’t help but be pissed when someone who has Medicaid get their GLP1 paid for when I pay for my insurance and have paid out of pocket for the last two years. I know I shouldn’t feel that way but I can’t help it. I’ve spent a ton of money bettering my health and my life. I know it’s a matter of employer and insurance but nothing makes me feel any better about it.

My mother gets her ozempic covered by Medicare .. but I'm glad that I'm not that old. My husband gets ozempic because he is a diabetic .. but I'm glad that I don't have that disease.

If Medicaid covered GLP-1 drugs for weight loss in my state, I still wouldn't be jealous of anyone because I'm glad that I'm not so poor that I needed Medicaid in the first place. I save my anger for the pharma companies and the people that are in bed with them for the high cost of the drugs. I also get mad at the people who think its just fine and dandy to treat obesity as a moral failing and not a legitimate medical issue .. which enables all of our insurance companies to deny us access in the first place (including to people on Medicaid.)