California Ending Coverage for Weight Loss Medications

Medical Q&A [Moderated]
1

I just got bad news that Medi-Cal is going to stop covering weight loss medications, including Zepbound, starting January 2026. The anxiety I’m feeling over this is absurd. I can’t imagine going back to how I was after being on this medication for multiple years. I spoke about my progress with the medication here a few times, but to recap I lost 100 pounds, had skin removal surgery, and finally started feeling okay with the way I look.

Losing this medication is devastating. I have no faith I’ll be able to continue to keep the weight off, and fully expect to return to my previous self at some point.

Should I feel as hopeless as I do? I went off the medication during my surgery and gained 20 pounds in rapid time.

I’ll never understand the why these medications are being treated this way when they’re such a boon for society. They solve so many health related issues and would end up saving everyone money in the long term.

2

I’m very sorry to hear about this.

Given that these medicines are costly, if you do not have the means to use some of the direct access routes, I would discuss alternative, non-GLP-1 agonist options with your physician. Although they may be less potent, they are likely to be more accessible (and available in inexpensive, generic formulations in some cases, e.g. phentermine-topiramate), and may mitigate some of the rebound risk after coming off. With that said, that rebound risk is variable between individuals, with a large fraction of people being able to maintain at a lower weight than they were at pre-treatment.

Hopefully with some time and increased competition, costs continue to come down, and returning to this therapy becomes a feasible option for you again.

3

My spouse takes these and they are not covered. They were not overweight “enough”…like barely below threshold. They’ve lost all the weight and so now absolutely do not qualify.

We were able to get it from a compound pharmacy for much, much less than the MSRP. Comes out to 200/mth dose. Also, she takes it at less than prescribed. Kind of self tuning to figure out where her appetite balance is…..but kept the higher dose to stretch it out a bit extra.

Everyone’s financial situation is different, so I won’t presume. But that does bring it down to much less than most other big expenses like insurance premiums, rent/mortgage, car note, utilities, and even many phone bills.

If you must go commercial, there are manufacturer coupons, copays, and discounts that can bring it down some depending on the specific manufacture that can bring the cost down a good bit (though not as low as a compound pharmacy if you’re paying cash).

My last recommendation is a little more complicated. I do data analysis and geek out a good bit on health plan optimization. I consistently find that High Deductible Health Plans + HSA’s out perform higher premium plans for out of pocket costs as long as you max out your HSA contribution. It typically takes 1.5y of HSA to have a savings equal to your family max out of pocket to absorb any big emergency year events. The math usually works out very close between plans…except with HSA plans the money goes to your HSA account (pretax) and you can spend it on what you want.

You may consider this to reduce your medicine costs if they’re out of pocket. Basically, instead of spending your premium on…premiums, you can spend it on your medicine.

4

Thank you both for the replies.

I didn’t know the rebound risk was variable, as I mostly heard that nearly 100% of those who stopped regained their weight over time. That’s something to be optimistic about, but I won’t lie, I’m not too hopeful. This new “identity” that weight loss has given me has opened so many doors in my life and the thought of returning to my previous weight has affected me mentally far more than I anticipated. In hindsight I probably should have been more prepared for this.

jkyle, I’m going to look into compounding pharmacies as a route but the whole thing seems pretty shady. Then again it will likely be the only way I can afford the medication.

It’s funny, I just got a new job and this added expense essentially cancels out any gain in financial freedom I would have had otherwise. I planned on putting the extra finances toward healthier food choices as well!

It just doesn’t make sense to me. Is it not obvious that obesity is one of the biggest factors in declining public health, and that treating it would lead to a healthier population that by nearly all metrics would save money?

I don’t understand the logic behind removing this coverage.

5

The companies have done their homework. The up-front costs are still too high, cost savings from reducing complications of excess body fat take years (if not decades) to manifest, and even then, these complications still don’t affect 100% of the population with obesity. As of the most recent analyses I’ve seen, metabolic/bariatric surgery remains more cost-effective than anti-obesity medicines. Prices still need to come down more for things to be more clearly cost-effective.

6

Yeah, I wouldn’t go to some random compounder by any means. Ours was recommended by our doctor. They’re local (US based down the road from us), not some mail order Ali Express vendor.

So they’re FDA regulated and all their ingredients must be sourced from FDA-registered sources.

They do per patient compounding, so the actual formula aren’t regulated. But, and this is typical, they provide a two ingredient compound of the GLP-1 and Vitamin B-12. So it’s not some weird or complex combination.

I would wager the actuaries aren’t looking at long term cost savings. Since the issues from obesity are chronic, they take a years to build up to expensive health issues. People shift and change insurance providers throughout life. So what they see is somewhat of a binary case. Relatively young, obese patients that have a high likelihood of developing chronic diseases in the future but also a high likelihood of leaving the risk pool before they’d develop those issues (or not). And older new patients who already have those chronic diseases.

Classic tragedy of the commons. No one invests in early care because no one can guarantee they’ll benefit from the later health gains.

It’s a weakness of our system. Only regulation will solve it. Then everyone is guaranteed to benefit from early investment.

7

Thank you both again for the replies.

That makes sense Dr. Baraki. I always appreciate your candor. I’m really hoping I can hold out until things change for the better.

I have an appointment with my endocrinologist next week and I’m sure he’ll have advice on this situation. I’m curious what he will say about the compounding pharmacy route that jkyle suggested.

8

Oh, I also heard a recent podcast on the high rates of regaining weight with GLP-1. I’m pretty sure it was on sigma nutrition.

When they dug into the details, it seems to be purely a function of whether the subject changed their lifestyle or solely relied on the GLP-1. e.g. if they didn’t become more active, exercise, etc. and maintained the same dietary habits (just less) when they stopped, they put the weight back on as their appetite increased.

Those that made lifestyle changes in diet and exercise at the same time tended to keep the weight off.

9

Ah in that case it’s a toss up for me. I’ve built some better habits but not everything is perfect. This dread I’m feeling is unreal. It feels like the trajectory of my life is no longer in my hands.

10

That feeling of dread you note here feels rough even when I read this, and I am sorry you are going through this. This is most definitely TOUGH news, and there is quite a bit that this brings up for you. You have made PROFOUND progress in your health, and I know it’s scary to think about what it would be like if you lost this progress. Very, real and understandable feelings here.

May I kind of “sit” with you a bit on this? It feels a bit odd saying it that way, but I hope it makes sense. What I mean is that I think there is some room to feel this way when you’re initially hit with news that could really change things for you. It sucks.

I don’t want to move too quickly to other ideas that aren’t really going to feel like solutions here because I don’t think we have a solution that really easily and quickly “fixes” this. There are too many things at play for this to be simple. You could purchase the meds directly from the manufacturer, but that is expensive. Many people can’t afford this. You could look into compounding, however that is far less regulated. I echo Austin’s suggestion that you continue this conversation with your MDs about other options. There are other things you could use to provide some help here. It may be different, but there are other meds that have the potential to provide you some help.

And that is one of the two big things I am thinking about as I read your posts here: there are options for help (even if different) and secondly you have indeed done work to get where you are now. Nothing is going to be perfect- the help (meds, a coach, a therapist, social support, a training program, accountability, your habits, routines, and tools), but all of these things can and do make a difference. As this year ends, this is your time to take stock of the helps/aids you do have, what you have access to, and what you can implement. This might feel more “intense”, yes. It might mean you are taking more time each day to care for this. That time is costly too, as is the mental load. But if you have some time and space for this, you can use it. And you have done positive things/work for yourself in this process. Again, nothing is perfect, so the habits you have built are going to be meaningful. Now is a great time to take inventory of these things, to appreciate them, and to trust yourself in these things.

I’m not suggesting some toxic positivity, affirmations that aren’t based in reality, or even that this will be easy. However, you can lean into the things you do have to use, the things you do have access to (or can add/get), and you can buckle in for what’s ahead.

Could you gain some weight going off the meds? Sure, but you might not. And if you do, you could lose it. Or you could gain and bit and then STOP gaining weight and maintain at a slightly higher weight. And for the rest of this year, you have the meds (and maybe into part of Jan as well), so this is a good time to assess what you do have to use here in 2026, during these few months when the food stress can be lower, so you have some space for some prep.

That was a lot, and I truly hope that in all of my words, you know that I feel that dread, and I am sorry. Feeling like you have this wonderful rug just pulled out from under you, so abruptly, and with so much uncertainly, sucks. Remember that something to help you is going to be better than giving up. And that you do in fact have some new habits, and those can really matter.

11

Thank you for the incredibly thoughtful reply Leah. You’re right that there are options. It would be very easy (and in character!) for me to fall into a pit of despair over this news and allow myself to destruct with old habits, all while brushing off my personal responsibility and inaction.

You’ve given me a ton to think about. There are things I can start improving NOW, while I still have the control the medication offers. I used to go to the gym for multiple hours almost every day before I got on the medication (I was the typical overweight powerlifter). I’ve spoken about it here a bunch. I need to stop expecting things to be perfect before I can take action, or even expecting any action I take to be perfect or it’s “not worth it”. This has been an ongoing obstacle in my life and likely played a large factor in the initial weight gain.

I actually think that’s why I responded so well to Zepbound. It was finally the thing that let my brain off the hook. It took the onus of weight loss and being perfect out of the equation and allowed me to focus on other things. I know it’s the not the only reason, but I do feel it played a major part in my current career, education, and life outcomes. I’ve made massive progress in that regard in the last few years and it’s likely because the medication smashed a lot of mental walls that held me back.

That’s where the fear comes from. I don’t want this new life to go away. It’s like you said, the “mental load” of weight management is costly, and I don’t want to put my new foundations to the test.

But there’s no getting around reality and you’re right, I don’t truly know the outcome. Your empathy and wisdom has altered my perspective just enough that I don’t feel totally hopeless.