I am writing to object to any additional barriers to GLP1 Agonist medication for patients suffering from the chronic condition of obesity, especially the vulnerable medicaid population. 

I am a bariatric medicine specialist. Most patients come to me after trying lifestyle change and commercial programs  for years. They are frustrated and exhausted. Many need the support of medication right away.  There is much scientific evidence that GLP1Agonists,  at this time,  are the most effective treatment. Delaying access when the physician  using best practices as the guide deems it necessary leads to more frustration and  loss of many patients as well as  more morbidity and mortality while waiting for access to the medication that is needed. 

Whatever the cost is  of covering GLP1 Agonists in this population, it will be less than covering the debilitation of spine and joint damage from obesity which includes but not limited to  hip and knee replacements that become necessary as a result of wear and tear , the medical consequences of obstructive sleep apnea which include heart disease and much more, and  the damage to the brain from intracranial hypertension to name a few consequences of obesity. For example,  a recent patient with a h/o of non alcoholic steatohepatitis and was regaining weight very fast which would have led to cirrhosis , was able to prevent cirrhosis of the liver with the use of  a GLP1A.  Another example is a   patient with medicaid and the diagnosis of prader willi syndrome which causes an uncontrollable appetite as a result of this genetic disorder. The only hope was a GLP1 A. This medication  has been very effective and he is now in control and losing weight. he would die within a year or two if he were not getting this medication. 

Access to this medication is vital for many patients and placing more barriers in front of access to it will lead to more morbidity and mortality and cost in other ways.

Sincerely,

Daphne L. Bryan, MD