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Medicaid coverage for weight loss medication is generally limited to people who have obesity and related health conditions, such as heart disease, high blood pressure, or type 2 diabetes. The specific medications covered may vary depending on the state and the individual’s health plan. Common weight loss medications covered by Medicaid include orlistat, phentermine, and topiramate. Prior authorization from a doctor is often required before Medicaid will cover these medications. There are also income and asset limits that must be met in order to qualify for Medicaid coverage.
Weight Loss Medication Coverage Under Medicaid
Medicaid coverage for weight loss medication varies from state to state. Some states may offer more comprehensive coverage than others. However, there are general criteria that need to be met in order to qualify for coverage.
- Be enrolled in Medicaid
- Have a BMI of 30 or higher (obesity) or a BMI of 27 or higher (overweight) with a comorbid condition such as high blood pressure, type 2 diabetes, or heart disease
- Have tried and failed to lose weight through diet and exercise
- Be under the supervision of a doctor or other healthcare provider
In most cases, Medicaid will cover the cost of weight loss medication if it is prescribed by a doctor and is medically necessary. Medically necessary means that the medication is needed to treat a health condition and is not just for cosmetic purposes.
Some of the weight loss medications that may be covered by Medicaid include:
- Orlistat (Xenical)
- Lorcaserin (Belviq)
- Phentermine and topiramate (Qsymia)
- Bupropion and naltrexone (Contrave)
It is important to note that not all weight loss medications are covered by Medicaid. Additionally, coverage may vary depending on the state in which you live. If you are interested in getting weight loss medication through Medicaid, you should contact your state Medicaid office to learn more about your coverage options.
| State | BMI Requirement | Covered Medications | Additional Requirements |
|---|---|---|---|
| California | BMI of 30 or higher, or BMI of 27 or higher with a comorbid condition | Orlistat, lorcaserin, phentermine and topiramate, bupropion and naltrexone | Must be under the supervision of a doctor or other healthcare provider |
| New York | BMI of 30 or higher, or BMI of 27 or higher with a comorbid condition | Orlistat, lorcaserin, phentermine and topiramate | Must have tried and failed to lose weight through diet and exercise |
| Texas | BMI of 35 or higher, or BMI of 30 or higher with a comorbid condition | Orlistat, lorcaserin, phentermine and topiramate, bupropion and naltrexone | Must be under the supervision of a doctor or other healthcare provider |
| Florida | BMI of 35 or higher, or BMI of 30 or higher with a comorbid condition | Orlistat, lorcaserin | Must have tried and failed to lose weight through diet and exercise |
Types of Weight Loss Medication Covered by Medicaid
Medicaid covers various weight loss medications to help individuals manage their weight and improve their overall health. These medications work by suppressing appetite, increasing metabolism, or blocking fat absorption. The specific medications covered may vary depending on the state and individual circumstances, but common types include:
- Orlistat (Xenical, Alli): Orlistat is a lipase inhibitor that blocks the absorption of fat from food in the digestive tract. It is available over-the-counter in lower doses and by prescription in higher doses.
- Lorcaserin (Belviq): Lorcaserin is a serotonin receptor agonist that suppresses appetite and increases feelings of fullness. It is typically used in combination with diet and exercise.
- Phentermine-topiramate (Qsymia): Phentermine-topiramate is a combination of two medications: phentermine, a stimulant that suppresses appetite, and topiramate, an anticonvulsant that also helps with weight loss. It is typically used in combination with diet and exercise.
- Naltrexone-bupropion (Contrave): Naltrexone-bupropion is a combination of two medications: naltrexone, an opioid antagonist that reduces cravings for food and alcohol, and bupropion, an antidepressant that also helps with weight loss. It is typically used in combination with diet and exercise.
To determine the specific weight loss medications covered by Medicaid in your state, it is recommended to contact your state Medicaid office or consult your healthcare provider.
| Medication | Brand Name | How it Works |
|---|---|---|
| Orlistat | Xenical, Alli | Blocks the absorption of fat from food |
| Lorcaserin | Belviq | Suppresses appetite and increases feelings of fullness |
| Phentermine-topiramate | Qsymia | Combination of a stimulant and an anticonvulsant that suppress appetite and help with weight loss |
| Naltrexone-bupropion | Contrave | Combination of an opioid antagonist and an antidepressant that reduce cravings for food and help with weight loss |
Weight Loss Medication Brands and Generics Covered by Medicaid
Medicaid coverage for weight loss medication varies from state to state. In general, Medicaid will cover weight loss medications that are approved by the Food and Drug Administration (FDA) for use in adults who are severely obese (BMI of 30 or higher). Some of the weight loss medications that are covered by Medicaid include:
- Belviq (lorcaserin)
- Contrave (naltrexone/bupropion)
- Saxenda (liraglutide)
- Qsymia (phentermine/topiramate)
Some states may also cover generic versions of these medications. The specific medications that are covered by Medicaid will depend on the state in which you live.
| Brand Name | Generic Name | Dosage | Approval Date |
|---|---|---|---|
| Belviq | lorcaserin | 10 mg once daily | June 2012 |
| Contrave | naltrexone/bupropion | 8 mg/90 mg once daily | September 2014 |
| Saxenda | liraglutide | 3 mg once daily | December 2014 |
| Qsymia | phentermine/topiramate | 7.5 mg/46 mg once daily | July 2012 |
If you are interested in taking weight loss medication, talk to your doctor to see if you are eligible for Medicaid coverage. You may also be able to find information about Medicaid coverage for weight loss medication on the website of your state’s Medicaid program.
Prescription Process for Weight Loss Medication Coverage by Medicaid
If you are considering using prescription weight loss medication, it is important to understand the coverage policies of your Medicaid plan. Each state has its own guidelines for covering weight loss medication, so it is important to check with your local Medicaid office. In general, Medicaid will only cover weight loss medication if it is medically necessary. This means that you must have a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition, such as diabetes, heart disease, or sleep apnea.
If you meet the medical necessity criteria, you will need to get a prescription from your doctor. Your doctor will need to submit a prior authorization request to your Medicaid plan. The prior authorization request will include information about your weight loss goals, your current weight, your BMI, and your medical history. Your Medicaid plan will review the prior authorization request and make a decision about whether or not to cover the medication.
Steps to Get Weight Loss Medication Coverage
- Talk to your doctor about your weight loss goals and whether or not prescription medication is right for you.
- If your doctor agrees that prescription medication is right for you, they will complete a prior authorization request.
- Submit the prior authorization request to your Medicaid plan.
- Your Medicaid plan will review the prior authorization request and make a decision about whether or not to cover the medication.
- If your Medicaid plan approves the prior authorization request, you will be able to fill your prescription at a pharmacy.
Medicaid Coverage for Weight Loss Medication
The types of weight loss medications covered by Medicaid vary from state to state. However, some of the most commonly covered medications include:
- Orlistat (Xenical)
- Lorcaserin (Belviq)
- Phentermine
- Diethylpropion
- Bupropion (Wellbutrin)
In addition to prescription medication, Medicaid may also cover other weight loss treatments, such as behavioral therapy and nutrition counseling. If you are interested in learning more about weight loss coverage under Medicaid, contact your local Medicaid office.
Wow! That was quite a journey together, wasn’t it? We dove deep into the world of weight loss medication coverage under Medicaid, and I hope you now have a clearer picture of the options available. Remember, these policies can change over time, so be proactive in revisiting this information periodically. Keep in mind that I’m always here to answer any questions you might have in the future. So, don’t be a stranger! Come back again soon for more insightful articles and discussions on various topics that matter to you. Stay curious, stay informed, and take care of yourself. Thanks for reading!