Episode 132: Clinical Conversations: Using EPSDT to Improve Access to Obesity Pharmacotherapy in Youth

In this episode of Obesity: A Disease, Dr. Suzanne Cuda, Executive Editor of the Obesity Medicine Association’s Obesity Pillars online journal, interviews Dr. Alaina Vidmar and Dr. Valerie O’Hara about their co-authored article, Using EPSDT to Improve Access to Obesity Pharmacotherapy, published in Obesity Pillars. Together they discuss using the federally mandated Medicated provision, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to access coverage for obesity treatment of youth in Medicaid programs.

Episode Guests:

Alaina Vidmar, MD

Valerie O’Hara, DO, FAAP, FOMA, DABOM

Episode Host:

Suzanne Cuda, MD, FOMA, FAAP

Related Resources:

https://www.sciencedirect.com/science/article/pii/S2667368126000422

Chapters

• (00:00:01) - Introduction and guest introductions
• (00:02:51) - What is EPSDT?
• (00:03:38) - Motivation for the review and personal experiences
• (00:06:58) - Navigating state vs federal Medicaid rules
• (00:10:17) - Why obesity deserves EPSDT-based treatment
• (00:13:05) - Fighting bias and stigma through EPSDT
• (00:13:51) - Finding resources and champions in your state
• (00:17:44) - Practical steps: denials, appeals, and letters of necessity
• (00:19:35) - Variability and challenges across insurers
• (00:22:29) - Transition to adulthood and coverage gaps
• (00:24:26) - Using comorbidities and creative coverage strategies
• (00:28:10) - Advocacy: crafting effective appeal letters
• (00:31:39) - Case study: dose escalation denial example
• (00:34:32) - Systemic barriers and future data collection
• (00:37:35) - Comparing EPSDT to Bridge and Balance programs
• (00:39:36) - Closing thoughts and thanks