Doctor makes case for expanding Nevada Medicaid coverage of anti-obesity drugs

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State lawmakers are considering expanding the types of obesity treatments covered by Nevada Medicaid, including approving weight-loss drugs like Ozempic for wider use and bariatric surgery for minors.
Steven Shane, a pediatric obesity doctor out of Reno, told lawmakers on the Senate Committee on Health and Human Services last week that, although these types of medicinal and surgical treatments are expensive upfront, covering them would financially benefit the state in the long term by reducing the cost of chronic diseases associated with obesity.
That's true, he added, even with potential Medicaid cuts looming.
Shane, who runs the Health Lifestyles Clinic at Renown Children's Hospital, told lawmakers that every day he is 'severely limited' in the care he can provide his patients.
'I typically cannot provide the best evidence-based therapies because Medicaid does not cover these options,' he said. 'It is no different than not covering other diseases such as asthma, diabetes or even cancer, which are all associated with obesity.'
Senate Bill 244 would require Nevada Medicaid to cover intensive behavioral and lifestyle treatment programs and certain surgical interventions to treat obesity. It would also cover an established national diabetes prevention program. A proposed amendment, which is supported by the bill sponsors, would also require Nevada Medicaid to cover at least one anti-obesity medication approved by the U.S. Food and Drug Administration (FDA).
The proposed amendment does not specify that the approved medication be in the class known as GLP-1s, but GLP-1s like Ozempic, Wegovy and Zepbound have received significant media attention and are now in-demand by both practitioners and the public.
These drugs mimic a hormone in the intestinal tract to balance the body's blood sugar levels. And while GLP-1 drugs have been around for years to help patients with diabetes, they are growing in popularity to treat patients in need of significant weight loss. That's because the drugs also send the brain a signal that reduces hunger.
Nevada Medicaid began covering Wegovy in March 2024, but only for adults with documented cardiovascular disease, such as a heart attack. Similarly, bariatric surgery is only covered for adults over 21 who have severe obesity and medical complications like diabetes.
Anti-obesity medicines are approved by the FDA and recommended by the American Academy of Pediatrics (AAP) for people ages 12 and up. The American College of Endocrinology recommends the drugs for adults who are overweight with medical complications and adults with obesity regardless of whether they currently have medical complications.
Nevada Medicaid currently covers medical nutritional therapy, but only 4 hours over 12 months. That's far below the amount medical experts say is needed to be effective. The AAP and the U.S. Preventive Services Task Force recommend children receive at least 26 hours or more of behavioral and lifestyle treatment over three to 12 months. Similarly, medical groups recommend adults receive at least 14 visits over 6 months.
Nevada's adult obesity prevalence for 2023 is 30.8%, according to the U.S. Centers for Disease Control and Prevention.
Shane referenced studies finding that a little over a quarter of 4th, 7th and 10th graders in Washoe County School District were considered obese and another 16% were considered overweight. Data was even worse for Clark County School District, where one-third of students were considered obese and another 17% were considered overweight.
State Sen. Fabian Doñate, who chairs the Senate HHS committee and is an administrator for a regional network of healthcare providers, expressed concerns about doctors who might begin recommending GLP-1s or bariatric surgery to every patient rather than attempting less expensive, less severe interventions like a behavioral health program that helps establish better eating and more physical activity.
'How can we ensure there are guardrails up, that the prescriptive treatments are actually medically necessary versus saying that any doctor can just recommend?' he asked.
Shane told Doñate the bill as written relies on doctors using best practices 'like we do for a lot of situations,' but he added that lawmakers could consider adding specific criteria or referencing established clinical guidelines into the bill language.
Shane noted the AAP currently recommends patients 12 and older participate in an intensive behavioral and lifestyle treatment and be offered anti-obesity medication simultaneously.
Doñate opined that the 'sensationalization of obesity medications' is cause for concern,as is the potential for the companies making these drugs to take advantage of mandated coverage.
'If I'm a pharmaceutical company and a state were to pass this requirement, the first thing I would do is send as many representatives that I could,' he said. 'There's nothing stopping me from doubling or tripling the cost of medication because now it's mandated via state law.'
GLP-1s range from about $940 to $1,350 a month before insurance, rebates or discounts, according to reporting by Stateline.
The Nevada Division of Health Care Financing and Policy, which houses the state's Medicaid program, estimated the proposed expansion would cost $165.4 million over the upcoming biennium. Nearly $64.3 million would come from the Nevada General Fund, with the rest estimated to be covered by the federal government.
Shane pointed to data from states that currently cover GLP-1s showing that utilization rates are not as high as people often assume them to be. Minnesota has the highest utilization rate at 3.16%.
'Many people don't take advantage when they're eligible,' he said.
Some studies have suggested the majority, if not all, of the upfront cost of GLP-1s are offset by the outcomes, particularly fewer emergency room visits related to cardiovascular diseases.
SB 244 is sponsored by three Democratic state senators from Southern Nevada — Roberta Lange, Rochelle Nguyen, and Michelee Cruz-Crawford.
Stateline's Shalina Chatlani contributed to this article.

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