Obesity and Diabetes in West Virginia

West Virginia has the highest prevalence of both obesity and diabetes in the United States. Obesity is a chronic condition in which a person has excess body fat and can lead to other health conditions such as cardiovascular diseases and sleep apnea. About 41% of adults in West Virginia are considered obese, a risk factor for type 2 diabetes. Type 2 diabetes affects the body’s ability to recognize insulin, which helps regulate blood sugar. In West Virginia, approximately 15% of adults have been diagnosed with type 2 diabetes. Both obesity and diabetes lead to high medical costs. Average yearly health costs for those with obesity are over twice as much as people without obesity due to the likelihood of developing other health conditions. According to 2017 estimates, diabetes resulted in a cost of over $2.3 billion in West Virginia.

Coverage and Cost of GLP-1 Agonists

Insurance coverage of GLP-1 agonists varies depending on the purpose and plan. Medicaid is required to cover GLP-1 agonists to treat type 2 diabetes, and private insurance companies commonly do so as well. A recent study found that 43% of individuals with diabetes have taken a GLP-1 agonist for treatment and it is highly effective. Insurance coverage of GLP-1 agonists for weight-loss purposes varies. The 2026 proposed rule for Medicare Part D would have allowed Medicare to cover GLP-1 agonists for weight-loss, however this proposal was reversed in April 2025. Of the 22% of US adults who are overweight or obese, only 24% had insurance that paid in full for these drugs for weight loss. 57% of individuals had partial coverage and 19% paid out of pocket. For example, West Virginia’s Public Employees Insurance Agency (PEIA), only covers GLP-1 agonists to treat type 2 diabetes and will not cover them for weight-loss purposes.

The primary concern surrounding GLP-1 agonists is their cost. Many people paying out-of-pocket describe the cost of these drugs as “prohibitive” and have had trouble paying for them, as they range between $900-1400 per month. Private insurance companies and Medicaid raise the same concerns, saying that GLP-1 agonists are one of the largest drivers in rising costs and covering them for weight loss would require increased premiums for everyone. A PEIA pilot program for 1,000 people taking GLP-1 agonists for weight loss found that it cost $7.5 million for one year. GLP-1 agonists are one of the top 20 most expensive drugs covered at PEIA. These top 20 drugs make up only 1% of total scripts but 42% of all medication expenses. PEIA stated that including coverage of GLP-1 agonists for weight loss would greatly increase costs, as over 70,000 of their members would be eligible for it. One concern that has also been raised to PEIA is the Gold Card Provider Program, which allows certain providers to prescribe medication without prior authorization. Some are worried that this policy needs to be clarified, as it enables providers to prescribe GLP-1 agonists for type 2 diabetes without prior authorization and could therefore be used to prescribe them to people for weight loss without oversight.

The majority of the public agree that insurance like Medicare should cover the cost of GLP-1 drugs for weight loss purposes, as the drugs are a good option for weight loss and making them more affordable will help improve their quality of life. Physicians have raised concerns about having to wait until patients become diabetic for insurance to cover the drugs. Instead, they could be used to help lose weight, which helps to prevent diabetes. Opponents, however, raise concerns about financial strain and say that it is not fair to people that will be met with higher insurance premiums to pay for these drugs for others. Some also worry that they will need to depend on GLP-1 agonists for the rest of their lives, as studies have shown that people that stop taking GLP-1 agonists regain their weight in about 8 weeks.

GLP-1 Coverage in Other States

GLP-1 agonist coverage among states largely varies in whether or not they are covered for weight-loss purposes. To date, only 13 state Medicaid programs, not including West Virginia Medicaid, cover GLP-1 agonists for weight-loss purposes. SB 743 (2024) was proposed to allow Medicaid to cover GLP-1 agonists for weight loss purposes as long as the recipient met certain BMI or co-morbidity requirements. This bill did not advance out of committee. Additionally, 16 state employee insurance plans cover GLP-1 agonists for weight-loss. Some of these plans have certain requirements for enrollment, however. Connecticut and Kentucky require recipients to enroll in a weight management program, recipients in Wyoming must meet a clinical definition of obesity, and those in Mississippi will only be covered if they have a co-morbidity like heart disease. If West Virginia wanted to pursue GLP-1 agonist coverage for weight loss for state employees or Medicaid recipients, these types of BMI or co-morbidity requirements are restrictions that could be considered in order to limit the amount of eligible members and reduce cost. Furthermore, West Virginia could wait to mandate coverage until cheaper generic versions become available, likely to be around 2032 when current patents protecting existing name-brand drugs expire.