As a Board Certified Obesity Medicine Specialist for a decade, I would like to comment on the plan to change the criteria for accessing Wegovy for Medicaid Patients. While as a taxpayer I applaud your efforts to maintain the solvency of the system by limiting prescriptions of expensive GLP medications, I think it is important for me to advocate on behalf of my patients. 

My Medicaid patients are often examples of the close statistical association between poverty and obesity, and massive weight loss (such as by Bariatric Surgery) is known to be associated with an improvement in employment and life circumstances.  GLP meds used as a tool with an individualized program such as mine can be truly life changing and can treat or prevent a number of expensive-to-treat comorbidities.  Wegovy can be used safely with hypertension and mental health meds/problems (common in this population) and has the best total weight loss of any of my medication options, so it is critical that it remain available to my patients without onerous criteria.  I agree that patients should be seen by EITHER a dietician or a medical provider (MD/DO or NP/PA) and should be engaged in exercise and dietary changes, and I don't have a huge objection to a BMI criteria of 35, OR 30 with any comorbidity (HTN, Pre-DM II, OSA, SUI, OA of weight-bearing joints, HLD) but I worry that if you change the criteria to be different that the package labelling (BMI 30 or 27 with comorbidity) that this may be a slippery slope leading to very reduced availability.  I also already spend a HUGE amount of time submitting these forms, often repeatedly and also repeatedly faxing practically the whole medical record when I and my staff should be seeing more patients or going home to our families and I am concerned that you will make this worse.

Thank you for your time,

Rachel Chastanet, MD, FACP, Board Certified in Obesity Medicine