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DON’T CURTAIL ACCESS TO WEIGHT-LOSS DRUGS  
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Shria Bucha
August 7, 2026
The Progressive
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_ A system that covers the consequences of a disease while refusing
to cover its treatment is just moving costs downstream. _

, Haberdoedas Photography/Pexels

 

Last November, a patient of mine—nineteen years old and established
in our primary care clinic in Massachusetts—came in for her annual
physical. She’d done everything we’d asked for her chronic
obesity. She’d traded the bus for a mile-long walk to school, every
day, both ways. She and her grandparents, who do the family’s
grocery shopping on an EBT card, had stretched what they could afford
into more balanced and nutritious meals. Yet the number on the scale
hadn’t moved. She asked, quietly and with exhaustion, if there was
anything else we could try.

There was. But getting there wouldn’t be simple. Before MassHealth,
Massachusetts’s Medicaid program, would even consider a prior
authorization for a GLP-1 medication, it required
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initial six-month trial of phentermine—a clinical cousin of
amphetamines. This step-therapy trial was required despite the 2026
American College of Physicians guideline
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recommending GLP-1s as the first-line treatment for obesity, ahead of
phentermine, on the basis of both superior efficacy and toleration. 
So, if only as the means to an end, we started phentermine.

My patient returned in May having taken phentermine at the highest
dose she could tolerate. To neither of our surprises, her weight
remained unchanged. She was finally ready—clinically and
bureaucratically—for the medication most likely to help.

And that’s when we heard that MassHealth would stop covering
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GLP-1s for obesity entirely, effective July 1, 2026. Massachusetts is
not alone. From 2025 to 2026, an estimated
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twelve million Americans lost coverage for Zepbound and another twelve
million lost coverage for Wegovy. Only thirteen state Medicaid
programs covered
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GLP-1s for obesity at the start of 2026, down from sixteen the year
before.

But here’s the thing: When effective medication disappears, patients
don’t stop needing treatment. They find another way. And the way
that many people have been finding it is dangerous. Up to two million
Americans received
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compounded versions of semaglutide—cheaper, unregulated copies
produced outside the U.S. Food and Drug Administration (FDA) approval
process—between November 2023 and November 2024.

As of early 2025, the FDA received
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more than 455 adverse event reports linked to compounded semaglutide.
Many of these involved dosing errors from patients who are
self-administering incorrect doses; some of these errors led to
hospitalization. The FDA has since submitted a proposal that would
close the last remaining legal pathway for large-scale compounded
GLP-1 production. The cheaper drugs that millions of patients have
come to rely on are disappearing from the market, with nothing safe
and affordable to replace them. 

Other patients are rationing doses across two or three weeks,
undermining their clinical effectiveness. Some are simply stopping,
leading to what studies show
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is rapid regains, with patients recovering 60 percent or more of lost
weight within a year of discontinuation, along with reversal of the
metabolic benefits gained during treatment. 

America has always been better at treating disease than preventing it,
and GLP-1s have exposed that logic at its starkest. Medicaid will
cover a patient’s diabetes once they develop it. It will cover
bariatric surgery, an invasive and permanent intervention, while
refusing to cover the medication that could make bariatric surgery
unnecessary for many patients.

This isn’t an oversight. It’s written into law. A
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statute explicitly allows
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Medicare and Medicaid to preclude coverage of any drug “used for
anorexia, weight loss, or weight gain,” a provision designed decades
ago for amphetamines and appetite suppressants with limited evidence
and real risks. Congress and the U.S. Centers for Medicare & Medicaid
Services have since interpreted that exclusion to apply to GLP-1s.
That makes treatments which reduce
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mortality by 20 percent and produce weight loss comparable to
bariatric surgery legally inaccessible to the patients who need them
most.

A system that covers the consequences of a disease while refusing to
cover its treatment isn’t making a cost-effective decision. It is
simply moving costs downstream into emergency rooms, dialysis centers,
and cardiac units, where they are larger, harder to reverse, and paid
by future budgets. Congress should remove that exclusion and treat
obesity the way we treat every other chronic condition—before the
complications arrive, not after.

My nineteen-year-old patient doesn’t have diabetes or chronic kidney
disease or heart disease yet. She came to us early, while prevention
was still possible, and did everything we asked. The system is waiting
for her to get sicker. She shouldn’t have to.

_This column was produced for __Progressive Perspectives_
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magazine, and distributed by Tribune News Service._

_Shria Bucha is a third-year medical student at Harvard Medical School
and a health policy researcher at the Program on Regulation,
Therapeutics, and Law at Brigham and Women’s Hospital. She also
serves on the board of Healthcare for Action._

* Healthcare
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* weight loss
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