Specialist Perspectives on West Virginia Medicaid Coverage Requirements for Semaglutide: A Qualitative Study of Perceived Barriers in a Rural State

Authors

• Yongjia Deng, West Virginia University School of MedicineFollow
• Katherine Shepherd, West Virginia University School of Medicine, Department of MedicineFollow
• Kanith Farah, West Virginia University School of Medicine, Department of MedicineFollow
• Jenna Sizemore, West Virginia University School of Medicine, Department of MedicineFollow
• Treah Haggerty, West Virginia University School of Medicine, Department of Family MedicineFollow
• Laura Davisson, West Virginia University School of Medicine, Department of MedicineFollow

Author Credentials

Yongjia Deng, MD Katherine Shepherd, MD Farah Kanith, MD Jenna Sizemore, MD Treah Haggerty, MD Laura Davisson, MD

Author ORCID Identifier

Yongjia Deng - 0000-0002-0658-0347

Jenna Sizemore - 0000-0002-3142-5672

Treah Haggerty - 0000-0001-8327-686X

Laura Davisson - 0000-0003-2863-9845

Keywords

West Virginia, WV, Medicaid, Health Policy, GLP-1, Qualitative

Disciplines

Health Services Research | Medicine and Health Sciences | Public Health | Rural Health

Abstract

Introduction

The WV Medicaid Drug Utilization Review Board approved a policy limiting prescriptions of Wegovy for cardiovascular risk reduction to cardiologists, vascular surgeons, and neurologists or those in consultation with them. This qualitative study explored specialists’ perspectives on the policy and its perceived implications for patient access to care and clinical practice in rural West Virginia.

Methods

To assess the perceived impact of this policy, we conducted semi-structured interviews with eight WV-based neurologists, cardiologists, and vascular surgeons between September 2024 and June 2025, while the original prescribing restrictions were in effect. Interview data were analyzed using thematic analysis to identify recurring themes.

Results

Five themes emerged: 

1. Limited education on GLP-1s
2. Limited clinical experience prescribing GLP-1s
3. Concern that the policy will hinder access to Wegovy for eligible patients with cardiovascular risk 
4. Concern about increased burden on specialty clinics and disruption of existing workflows
5. Recognition of the value of primary care-specialist collaboration in managing patients who may benefit from GLP-1s

Conclusion

Specialists reported limited familiarity with GLP-1s and expressed concerns about the policy's potential effects on patient access to care and specialty clinic operations. These findings underscore the importance of engaging stakeholders in policy development to support patient access to care and improve health outcomes.

Recommended Citation

Deng Y, Shepherd K, Farah K, Sizemore J, Haggerty T, Davisson L. Specialist Perspectives on West Virginia Medicaid Coverage Requirements for Semaglutide: A Qualitative Study of Perceived Barriers in a Rural State. Marshall J Med. 2026; 12(4) DOI: https://doi.org/10.33470/2379-9536.1532.