Dr. Amy Hess once had a patient rack up thousands of dollars in credit card debt to afford weight loss medication.
“It’s an astronomical price,” said Hess, who works for Community Health Network’s bariatric and medical weight loss program. “A majority of my time is just talking to patients about how we can get this medication covered.”
Many of Hess’s patients are on Medicaid, a government-based insurance that helps about one in five Hoosiers who have low incomes receive healthcare. That’s why the doctor was excited when Gov. Mike Braun’s administration announced July 30 that Indiana’s Medicaid program would cover these treatments.
Weight loss drugs mimic a hormone that lowers blood sugar, slows digestion and reduces food cravings. Many are manufactured locally by Eli Lilly and Co., a pharmaceutical giant headquartered in Indianapolis.
The state hasn’t announced when the program will be rolled out or eligibility criteria yet, but federal guidelines generally cover these drugs for people who have obesity and other related conditions, such as diabetes, hypertension, sleep apnea, high cholesterol or heart disease. Indiana has one of the highest rates of obesity in the nation.
“This is life changing for these patients,” Hess said. “They’ll be able to prevent diabetes and decrease their cardiovascular risk.”
But, there are some things experts are watching for. One is the continuity of funding.
The program covering weight loss drugs is a partnership between the federal government and states. Indiana will pay about $85 per person each month — a portion of the estimated $245 monthly price for Medicaid members. The rest, per Braun’s office, will be covered by federal contributions.
The program is slated to run through 2031. But Aparna Soni, an associate professor at IU Indy’s Richard M. Fairbanks School of Public Health, said states can choose to leave at any time. She noted Pennslyavnia’s decision to restrict its coverage after the demand for weight loss drugs alone cost the state’s Medicaid program an estimated $1.3 billion last year.
“If coverage is interrupted, patients are worse off,” said Soni, who studies health policy. “Stopping therapy tends to reverse the gains.”
A study from the University of Oxford found that people who go off the drugs usually gain back all the weight they lost within two years.
Concerns about ‘Medicaid churn’
Another issue is Indiana’s new restrictions for some Medicaid programs, including The Healthy Indiana Plan.
Starting in January 2027, people on The Healthy Indiana Plan, which covers low-income adults between the ages of 19 and 64, must meet monthly work requirements to keep their health coverage. The state will also check their eligibility more often.
Most people on the Healthy Indiana Plan are already working. But advocates warn they’ll face the burden of paperwork to prove it — and some who are qualified may be kicked off of Medicaid due to processing errors, strict timelines and income fluctuations.
There’s already some evidence of Hoosiers falling off Medicaid. An Indiana Capital Chronicle analysis found that Medicaid enrollment dropped by about 18% this year, with people facing procedural issues such as missed notices, new deadlines and changing documentation requirements.
Soni warned this “Medicaid churn” can affect patients trying to get treatment for obesity or diabetes.
“Eligibility redeterminations and coverage interruptions already break continuity for chronic conditions,” the health researcher told Mirror Indy.
Local advocacy groups estimate that nearly 400,000 Hoosiers will become uninsured due the state’s changes and Medicaid cuts in the Trump administration’s “One Big, Beautiful Bill.“
‘Not a magic pill’
Hess, the doctor from Community Health Network, said her patients losing the new Medicaid coverage for weight loss drugs would be disastrous for their care.
“It’s honestly malpractice to have to take someone off,” Hess said. “We know the benefits of this medication.”
But, she also said, people cannot rely on weight loss drugs alone.
“This is definitely not just a magic pill,” Hess said. “It’s a tool that treats the underlying biology of obesity, but it requires lifestyle changes as well.”
That’s why it’s safest for people to get a prescription from a board-certified physician who can ensure they meet the eligibility requirements and monitor their progress. Weight loss drugs can cause side effects, including nausea, diarrhea, vomiting and constipation. Some studies have linked them to kidney problems and pancreatitis.
During treatment, Hess works with patients to incorporate more protein into their diets. She also has them take up strength training and watch their water intake. Weight loss drugs can sometimes lead to dehydration or muscle loss.
Additionally, she said, it’s helpful for patients to see a dietician at the same time. That way, they can make long-term changes to nutrition and continue fueling their bodies.
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Mirror Indy reporter Mary Claire Molloy covers health. Reach her at 317-721-7648 or email maryclaire.molloy@mirrorindy.org. Follow her on X @mcmolloy7.
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