Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Guidance Document Change: This is a new form used to determine whether DMAS will cover certain weight loss drugs. (This process is called service authorization.)
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9/9/23  4:13 pm
Commenter: Susan Clapp, DNP

Changing requirements for GLP-1

I am a nurse practitioner and worked in the area of weight management, childhood obesity (classes) and cardiac rehabilitation from 2005 until 2018. I currently work as a primary care provider at a Free Clinic with most patients covered by Medicaid. GLP1 agonists have been embraced by my patient panel and many have seen successful weight loss for the first time in their lives. They have already been educated by their primary care and community health workers on nutrition, portion control and healthier choices.  Given the state of our economy, many are unable to access nutritious and inexpensive foods as they live in a food desert. The cheapest foods are often higher in calories and high in sugar. So, requiring a nutritional visit by a registered dietician (RD) is yet another barrier to accessing much-needed GLP-1 medication. Most plans will not cover a dietician consult and RD’s are difficult to find. Money is tight when rent is going up as well as gas and food. They have been given many educational booklets, provided 1:1 nutritional teaching and are aware of healthier food choices.  However, once they start seeing results with a GLP-1, they become additionally motivated to make better choices. Increasing the BMI requirement does not make sense when a BMI of 40 places them at morbidly obese and eligible for bariatric surgery.  Why don’t we use evidence-based medications to promote weight loss prior to surgical options?  Once patients have experienced a myocardial infarction and/or stent or bypass, they are very motivated to lose weight and make lifestyle changes. Don’t make them wait to be eligible for a GLP1 or have them meet additional requirements prior to obtaining these medications. Many weight loss drugs are contraindicated for those with a history of hypertension, heart disease or cardiac arrythmias.  I will not prescribe these higher risk medications for weight loss as this would not be appropriate. Primary care providers, caring for this vulnerable and marginalized population, have been so excited to track significant weight loss with our Medicaid patients whose BMI is 30-40.  They now can take lower doses of antihypertensives, decrease the dose of their diabetes medication and feel better about themselves. The positive results to mental health and depression from weight loss have been life-altering for my patients. Self-esteem is restored. They continue to visit the gym and meal-plan, but they now can see that it works with the addition of a GLP-1. Listen to those of us who work with Medicaid patients every single day.  Please do not limit access to this medication for the Medicaid population.  They deserve something positive in their lives.

CommentID: 220193