CHARLESTON, S.C. — Page Campbell, a 40-year-old single mother from Charleston, has long struggled with her weight. When her doctor recommended the injectable weight loss drug Wegovy ahead of bariatric surgery, she quickly agreed.
“I’ve struggled with my weight for so long,” said Campbell. “I’m not opposed to trying anything.”
Campbell began the medication in early April and, after four weeks, reported no side effects. Although she doesn’t use a scale at home, she said she feels positive about her progress due to her healthier diet and regular exercise. “It’s going to work because I’m putting in the work,” she said.
Wegovy is part of a class of injectable drugs known as GLP-1s, which have transformed obesity treatment by offering effective, low-risk options for weight loss. However, they remain financially out of reach for many Americans, as most private and public insurers still refuse to cover their high costs.
Campbell met those requirements, but only after submitting six months of documentation showing she had tried a 1,200-calorie diet and professional counseling. Her prescription is now approved for six months, after which she must prove she has lost at least 5% of her body weight and continued treatment efforts to qualify for renewal.
“It’s not just, ‘Send in a prescription and they cover it,’” said Dr. Kenneth Mitchell, Campbell’s physician and medical director at Roper St. Francis Healthcare. “It’s rather arduous. Not a lot of folks are going to do this.”
Mitchell supports the state’s decision to cover GLP-1s but recognizes the cost is a major obstacle. Wegovy, manufactured by Novo Nordisk, reduced its list price from $650 to $499 a month for cash-paying customers in March. Still, many GLP-1s cost over $1,000 per month for insurers, and patients may need to stay on them for life.
That financial burden has led some states to drop coverage. North Carolina’s State Health Plan, for example, ended GLP-1 coverage for state employees after forecasting a $1 billion cost over six years. In contrast, North Carolina’s Medicaid program will continue offering the drugs, estimating $16 million in annual expenses.
South Carolina Medicaid, which covers fewer residents, anticipates spending $10 million annually on GLP-1s and nutritional counseling—$3.3 million of which will be funded by the state, with the rest coming from federal Medicaid contributions.
Despite national pressure, the federal government is holding off on expanding access. In April, the Trump administration announced it would not finalize a proposed Biden-era rule to allow Medicare and Medicaid to cover GLP-1s for weight loss, potentially limiting access for over 7 million Americans. At the same time, the FDA is considering removing lower-cost, compounded versions of these drugs from the market.
Health and Human Services Secretary Robert F. Kennedy Jr. said GLP-1s are “extraordinary drugs” and hinted at potential future coverage for obesity treatment under Medicare and Medicaid if prices drop. “We’re going to reduce the cost,” Kennedy said.
Public health leaders in South Carolina are cautiously optimistic. While they applaud Medicaid’s decision, they note that the state’s new $1.5 million federal obesity prevention plan does not address GLP-1s. Instead, it focuses on improving nutrition, physical activity, and community infrastructure.
“There is a need to bring it all together,” said Dr. Brannon Traxler, the state’s chief medical officer. She suggested that a more comprehensive plan could include both medical and lifestyle-based interventions.
Campbell, for her part, is taking that holistic approach. In addition to weekly Wegovy injections and changes in diet and exercise, she underwent weight loss surgery in late April.
“Weight loss is my biggest goal,” she said. “It’s one more thing that’s going to help me get to my goal.”
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