Depending upon where you live, the answer will vary. Just like different insurance plans may have exclusions of coverage for weight loss-related programs and treatment, so do the insurance plans provided for by state Medicaid programs.
As part of the Strategies to Overcome and Prevent (STOP) Obesity Alliance, the George Washington University School of Public Health and Health Services Department of Health Policy research team released a report in September 2010 titled, “A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States.” Around the same time, GW published side-by-side reports highlighting how each state tackles obesity through insurance coverage, state regulations, and incentive programs.
The question “Will Medicaid Pay for Weight Loss Drugs” is answered in the August 2010 report Medicaid Fee For Service Treatment of Obesity Intervention (pdf). Organized by state, this research booklet provides state-specific information related to preventive coverage for adults, pregnant women and children (up to 21), coverage related to co-morbidities, pharmaceutical coverage, surgical coverage, and incentive programs. Although Medicaid is not required to cover weight loss medications, many states have opted to add coverage for patients fitting specific criteria.
Common pharmaceuticals prescribed for weight loss include the lipase inhibitors
Xenical (Orlistat), Meridia (Sibutramine), and Adipex (Phentermine). A lipase inhibitor works by blocking the enzyme lipase which helps to break down dietary fat. If the consumed fat cannot be broken down, it fails to be absorbed into the blood stream and will be passed through the gastrointestinal tract instead. The first of these medications (Xenical) was approved by the FDA in 1999.
In general it appears that amphetamines, amphetamine-like drugs, and appetite suppressants are not covered when used for weight-loss purposes.
No Coverage At All
Twenty-seven states exclude any coverage of drugs commonly prescribed for weight-loss purposes. These states include: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Washington, West Virginia, and Wyoming.
Partial Coverage
Some states provide coverage for lipase inhibitor drugs or amphetamines, but not specifically for the diagnosis of obesity. These states include: Idaho, Michigan, Minnesota, Missouri, Nebraska, New York, and Oregon.
Prior authorization may require that the patient have a covered diagnosis such as Type II diabetes (Minnesota), dyslipidemia (Missouri), or other condition (Nebraska, New York, Oregon). States which specify coverage of Xenical (Orlistat) include Minnesota, Missouri, and Nebraska. In addition to Xenical, Oregon Medicaid covers Meridia (Sibutramine) and Adipex (Phentermine). Idaho and New York do not specify which lipase inhibitors are covered under Medicaid.
