Two years ago, Sue Prentiss got a sobering reality check at her doctor’s office. The news was blunt: She qualified for bariatric surgery, a procedure for patients whose weight poses life-threatening risks.

She was aware of her weight and had tried everything from high-intensity workouts to weight loss programs and diets. Nothing seemed to help until she started taking GLP-1 medications.

Prentiss said between then and now, she had lost almost 80 pounds. 

But at a $500 out-of-pocket monthly fee, every refill is a financial pinch.

“I’m just getting by, but I’m so much healthier, and if this can work for me, think about everybody else’s life where this would impact,” said Prentiss, a state senator.

To keep up with the cost, she’s made hard choices like cutting back on retirement contributions and squeezing her budget wherever possible.

Now, Prentiss is sponsoring Senate Bill 455, which would require the state to provide GLP-1 medications under the state Medicaid plan as a treatment for people with obesity.

As of January, New Hampshire’s Medicaid program has ended coverage for GLP-1 drugs like Saxenda, Wegovy and Zepbound for weight loss. The state still covers the medications when they’re part of a treatment plan for other chronic conditions, such as type 2 diabetes, certain cardiovascular diseases, severe sleep apnea and Metabolic Dysfunction-Associated Steatohepatitis (MASH).

According to the New Hampshire Department of Health and Human Services, the state paid managed care organizations $49.5 million to cover GLP-1 medications between July 1, 2025, and June 30, 2026. The policy change in January reduced that cost to $41 million.

With these drugs gaining popularity, the state estimated that if were to resume covering GLP-1s for weight loss, it would need to spend an additional $24.2 million on top of the $41 million per fiscal year.

Jonathan Ballard, chief medical officer at DHHS, said the agency opposes the bill, which would require Medicaid coverage for anyone with a body mass index above 30 seeking GLP-1 medications specifically for weight loss.

Ballard said the state cannot afford such an expansion when budgets are already tight.

“The department does not have this money today,” he said. “So, living within the realities of our current budget, there will be significant trade-offs. We will have to cut other things that are very important to the health and well-being of New Hampshire to pay for this unless there’s some change.”

GLP-1 drugs carry a steep price tag that puts significant pressure on state budgets, particularly within Medicaid programs. Several states, including California, Pennsylvania and South Carolina, have moved to drop coverage of these medications for weight loss.

Prentiss initially drafted her legislation with private insurers in mind, but later pivoted to focus on Medicaid to serve more vulnerable populations. She is covered by commercial insurance and said the outcome of the bill will not personally affect her.

Lost coverage

GLP-1 medications mimic a natural hormone in the gut that helps regulate blood sugar, digestion and appetite.

Sarah Finn, section chief for obesity medicine at Dartmouth Health, said she has seen firsthand the impact on her patients after the state dropped Medicaid coverage for weight-loss GLP-1 drugs. 

Without access to these medications, patients experience increased hunger, cravings and persistent “food noise,” as their bodies attempt to return to a higher fat percentage, a process known as metabolic adaptation, she said.

“This is the reality of the state I’m in right now, where I don’t have options except bariatric surgery for my Medicaid patients and a lot of times patients don’t want to do a surgery,” said Finn, at a hearing for the bill on Wednesday. “What I have to tell that patient is there’s nothing I could do to advocate.”

The Department of Health and Human Services faced a $51 million budget cut when the New Hampshire Legislature passed its biennial budget last year, forcing the department to reduce several services.

While Prentiss acknowledges the financial strain on the department, she wants the state to consider the long-term impact of using GLP-1s to prevent chronic conditions like diabetes, which is largely linked to weight gain and can drive up costs for the state over time.

“By driving down obesity, we can drive down the costs that are related to it,” she said. 

Prentiss remains on GLP-1 medications and said she feels much healthier than before.

She said that after a few months on the drugs, her blood sugar levels and kidney function began trending toward more normal ranges.

“It’s not cosmetic,” she said. “Obesity is a medical condition.”