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

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:  Limited education on GLP-1s Limited clinical experience prescribing GLP-1s Concern that the policy will hinder access to Wegovy for eligible patients with cardiovascular risk  Concern about increased burden on specialty clinics and disruption of existing workflows 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.