States Are Walking Back Medicaid Coverage for GLP-1s

[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.)

 

[MsGizmo]

Oh .. and while on the topic of insurance companies (including Medicaid) being allowed to ban GLP-1s for obesity .. they typically cover many treatment options for drug addiction, alcoholism and smoking cessation (patches, nicotine gum and counseling.)

By allowing the government to exclude coverage for obesity drugs in Medicaid we are ALSO allowing all the other insurance companies to do it too. When you agree to the Medicaid exclusion you are admitting to the world that you also think that obesity isn't caused by a legitimate medical condition.

 

[MillyFanilly]

Oh .. and while on the topic of insurance companies (including Medicaid) being allowed to ban GLP-1s for obesity .. they typically cover many treatment options for drug addiction, alcoholism and smoking cessation (patches, nicotine gum and counseling.)

By allowing the government to exclude coverage for obesity drugs in Medicaid we are ALSO allowing all the other insurance companies to do it too. When you agree to the Medicaid exclusion you are admitting to the world that you also think that obesity isn't caused by a legitimate medical condition.

You are right. And that’s where my anger needs to be. Big Pharma. Thanks for your perspective. It’s appreciated.

 

[adria37]

I absolutely hate insurance companies. I do oncology/hematology and see the bullsh*t denials for lifesaving drugs but I also know that most of the US is obese. I know the state employees health plan had to stop covering it because they were going broke just providing one class of drug. I think the cost is what we should be angry about. Why are they even allowed to charge these crazy amounts. I am all for making a profit but selling a drug that costs pennies for 1500.00 is ridiculous.

 

[Mimi2]

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

Well most bariatric surgeons are not just bariatric. Usually they specialize in trauma or general surgeries. That’s where the leverage comes from. If a hospital loses their bariatric program, may hurt the bottom line but not the accreditation but take their trauma or surgical programs. Now you’re talking about losing accreditation. But the big guns that does the lobbing is the AMA (American Medical Association), plus CMS/medicare medicaid. Why pay big pharma $$$$ when they can have a life long patient? Weight loss patients literally see their weight loss doctor multiple times prior, countless times during the weight loss process and yearly thereafter and that’s if there are no complications! The complication rate is unbelievable, it’s just not talked about. I’ve seen it first hand.