Obesity Groups Support Medicaid Coverage for Comprehensive Obesity Care & Urge Passage of SB 3195 and HB 2456

The Obesity Action Coalition (OAC), The Obesity Society (TOS), and the American Society for Metabolic and Bariatric Surgery (ASMBS) strongly support coverage of Food & Drug Administration (FDA) – approved obesity medications in the context of comprehensive obesity care for Medicaid beneficiaries. Improved access to obesity treatments that have been proven safe and effective, including nutrition counseling, behavioral and lifestyle interventions, FDA-approved obesity medications, endobariatric procedures, and metabolic and bariatric surgery, is critical to ensuring the health and productivity of all state residents. For these reasons, we support passage of SB 3195 and HB 2456, which would remove the exemption for covering obesity medications under the state’s Medicaid program.

Hawaii ranks 49th in states impacted by obesity, with nearly 26% of adults living with obesity and another 33% affected by overweight. Obesity and diabetes disproportionately affect people of color and of lower socioeconomic status, which are important factors that often determine access to health care. Dispari-es
further exacerbate Hawaii obesity statistics and health outcomes, with 31% of black and 31% of Hispanic residents living with obesity compared to 19% of white residents. Persons with low incomes are more likely to be Medicaid recipients or uninsured, have poor-quality health care, and seek health care less often; when they do seek health care, it is more likely to be for an emergency.

The total cost of obesity in the United States is $1.7 trillion, and healthcare costs are 34% higher for people with obesity. Expanding access to obesity care will help decrease the numerous illnesses and comorbidities that plague Hawaiians, while improving health outcomes and healthcare savings. It is important to remember that while some obesity medications may be costly, state Medicaid programs receive very generous rebates and discounts from manufacturers and the Federal Government. In addition, creating a system where Medicaid beneficiaries will have access to the full range of obesity treatment services — such as nutrition counseling, intensive behavioral therapy, obesity medications, and metabolic and bariatric surgery — will provide an avenue for addressing so many other costly obesity-related conditions such as Type II diabetes, hypertension, and cardiovascular disease.

Throughout the last 5 years, there have been numerous studies and reports issued on the cost-effectiveness of providing coverage for obesity treatment – with the most recent being the release of the October 29, 2025, Institute for Clinical and Economic Review (ICER) Evidence Report assessing the comparative clinical effectiveness and value of semaglutide and -rzepa-de. ICER found all three medications to be highly cost-effective at conventional thresholds, with incremental cost-effectiveness ratios estimated at $53,400 per quality-adjusted life year gained for -rzepa-de, $61,400 for injectable semaglu-de, and $69,300 for oral semaglutide.

Another example is the October 2025 report from Global Data, entitled the “Economic Benefits of Obesity Treatment,” which assessed previous literature findings on the value of obesity treatments to help policymakers be better informed regarding coverage and policy decisions. This included 31 studies (2012–2025) on the economic value of four major interventions- lifestyle programs, first-generation medications, modern medications, and metabolic and bariatric surgery. The report’s key takeaway was that investing in effective obesity treatments not only improves health outcomes and quality of life but also delivers meaningful savings.

The estimated annual medical savings (adjusted to 2025 dollars; varies by insurance type) would be as follows: $200-$1,220 for lifestyle programs and first-gen medications; $760-$4,720 for modern medications; and $940- $5,830 for metabolic and bariatric surgery.

The University of Southern California Schaeffer Center study (2023) on the “Benefits of Medicare Coverage for Weight Loss Drugs” found that trea-ng obesity can reduce diabetes (-8.9%), hypertension (-2.3%), heart disease (-2.6%), cancer (-1.3%), and disability (- 4.7%) over 10 years in private insurance coverage and Medicare. These results would also likely apply to state employee and state Medicaid programs.

In addition, a recent AON study of 139,000 U.S. employees revealed that patients treated with GLP-1 medications experienced a 7% lower medical cost trend by year two compared to similar patients who did not receive treatment for their obesity. In contrast, the untreated group saw their medical cost trend rise to 14%. This is a 50% reduction in health care spending for patients taking obesity medications. Most notably, GLP-1 use led to a greater than 40% reduction in major adverse cardiac events such as heart attacks and strokes and significantly reduced the incidence of diabetes—outcomes that directly benefit both patients’ lives and the state’s healthcare expenditures. The study was so impactful that the benefits consulting firm started a program to cover these obesity medications for their own employees.

Finally, the Hawaii Medicaid program should take into account the lower prices for these obesity medications that the Trump Administration is rolling out as part of a new 402 demonstration project for 2026 and a Center for Medicare and Medicaid Innovation demo beginning in 2027 that will allow Medicaid programs (that opt in) to purchase these GLP-1 medications at a monthly cost of $245.

Removing the state’s prohibition on obesity medication coverage would be a critical step toward ensuring that Medicaid beneficiaries who are affected by obesity have access to affordable, individualized medical coverage for science-based treatments in the same way other chronic diseases are managed, allowing them to be treated with dignity, respect, and equality that is offered to their peers. We collectively believe that expanding access to obesity medications and treatment in Medicaid will not only improve health outcomes for state residents but will also reduce healthcare costs to the state.

For more information, please contact OAC, TOS, ASMBS Public Policy Advisor Chris Gallagher via email at [email protected]