The Obesity Action Coalition (OAC), The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) remain strongly opposed to Governor McKee’s proposed budget, which would eliminate Medicaid coverage for GLP-1 medications for obesity effective October 1, 2026.

Our organizations strongly support coverage of Food & Drug Administration (FDA) – approved obesity management 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 management medications, endobariatric procedures, and metabolic and bariatric surgery, is critical to ensuring the health and productivity of all state residents.

Rhode Island has been a leader in obesity care coverage throughout the last decade. For these reasons, we are disappointed that Governor McKee appears to be suggesting that GLP-1 coverage will only be allowed to treat type 2 diabetes — despite FDA approval for other conditions in addition to obesity such as cardiovascular disease, obstructive sleep apnea, and metabolic-associated steatohepatitis (MASH, or NASH with fibrosis). Would Medicaid beneficiaries still be able to access older generation obesity management medications? Will there be any grandfathering for those individuals currently taking GLP-1 medications? There will be critical consequences for thousands of Rhode Islanders should they lose access to this critical treatment tool.

Recent projections from the semiannual Revenue Estimating Conference estimate that the state will have an additional $233 million in funding for the upcoming 2026-2027 budget year. This is truly a fantastic development which legislators must utilize to maintain GLP-1 coverage for our state’s most needy beneficiaries under Medicaid. Doing so will address many of the above concerns and enable Rhode Island to continue its leadership role as one of the top states providing its citizens with access to covered comprehensive obesity care.

Rhode Island ranks 40th in states impacted by obesity, with 30.8% of Rhode Island adults living with obesity and another 36.6 affected by overweight. Obesity and diabetes disproportionately affect people of color and of lower socioeconomical status, which are important factors that often determine access to health care. Disparities further exacerbate Rhode Island obesity statistics and health outcomes, with 38.5% of black and 33.9% of Hispanic state residents living with obesity compared to 29.5% 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.

Throughout the last 5 years, there have been numerous studies and reports issued on the cost-effectiveness of providing coverage for obesity treatment – such as 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 tirzepatide. 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 tirzepatide, $61,400 for injectable semaglutide, 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 take away 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.

Finally and most relevant, a recently published article in Diabetes, Obesity and CardioMetabolic Care entitled the “Benefits and Costs of Treating Obesity Among Adults in the Medicaid Program,” demonstrates that changes in body weight and cardiometabolic risk factors associated with providing specific obesity treatments would reduce the incidence of several chronic conditions, generating multiple social benefits such as medical cost savings, productivity improvements, additional quality-adjusted life-years, and mortality reductions.

• Among people with no prior history of type 2 diabetes, results indicate that second-generation obesity medicines (GLP-1s) can prevent 45% of new cases compared with no treatment.
• Second-generation obesity medicines would also reduce hypertension incidence by 45% and were the most effective across all interventions.
• Coronary heart disease, heart attack, and stroke incidence would decline by rates of 18%, 31%, and 27%, respectively, with use of second-generation OMs.

These studies demonstrate that while medical savings offset only a portion of treatment costs, obesity interventions generate substantial social value through improved long-term health and productivity. These findings support expanded Medicaid coverage as a strategic investment in population health, demonstrating value that challenges conventional short-term, budget-focused coverage decisions that currently limit access to evidence-based obesity treatments for millions of adults.

Of course, the state can also participate in the Centers for Medicare and Medicaid Services’ BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) model, which broadens access to evidence-based obesity treatments at lower costs through federal negotiations. Meanwhile, increased competition and innovation continue to place downward pressure on GLP-1 prices, and manufacturers have shown a willingness to negotiate directly with states.

Maintaining Medicaid coverage for FDA-approved obesity management medications is essential to 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 access to all obesity treatment avenues 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].