Advice for rural patients seeking GLP-1 access, affordability in South Dakota
By
Lori Walsh
Published August 10, 2026 at 1:51 PM CDT
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A temporary federal program is helping more South Dakotans gain access to GLP-1 medications to treat obesity. Beginning in July, eligible Medicare Part D beneficiaries pay a fixed rate of $50 per month. It’s a pilot program set to end in December 2027
Meanwhile, rural South Dakotans seeking access to the popular weight loss <a href="https://healthylife7.com/weight-loss-drugs-how-are-glp/” title=”Weight-Loss Drugs: How Are GLP”>drugs face challenges. SDPB’s Lori Walsh talked with Jessica Strobl, PharmD. Strobl is Vice President of Pharmacy for Lewis. Lewis has 60 pharmacy storefronts in South Dakota, Minnesota, and Iowa
A transcript of this interview follows:
With GLP-1 use becoming so popular — and rightfully so, they’re a very good class of medications. They’ve actually been around for a long time, used for diabetes first, and then weight loss, which is obviously why they’ve gotten so much press lately. Everyone loves to learn about ways that they can lose weight
They are a very good class of medications that have become very popular. And I think that traditionally people in metro areas, Sioux Falls and surrounding areas, have a little easier access to physicians and to specialists and other ways to see healthcare providers. But what really makes Lewis stand out —and the Sanford and Lewis relationship — is our rural presence
We’re able to give patients access to health care in communities that don’t always have a large clinic presence or even a specialist on site. So we’re able to bring that care right to a patient at their community pharmacy and give them access to ask questions and help them with their care, navigate coverage. It’s nice to have the availability to do that for our rural patients
LORI WALSH
How often is the pharmacist, the rural pharmacist, the first person who is answering questions about medications, especially something new?
You said it’s been around for a while, but it might be new to you, GLP-1s
JESSICA STROBL
Because pharmacists are so accessible, it’s very common for patients to start with their pharmacist to ask questions first. If you think about your primary care provider, for instance, you might see them once a year, have a wellness check, or maybe go in and see them if you have something pop up. So maybe seeing them twice a year. If you’re on a regular medication, you’re going to see your pharmacist every month or at a minimum every three months. Sometimes we fill a three-month supply at a time for patients.
But that’s a lot of touch points, besides people coming into the pharmacy for their over-the-counter needs or even picking up toilet paper or groceries. You have access to that pharmacist who is a trained health care provider right there. So we’re very easily accessible, easy for patients to walk up and ask questions. And at Lewis Drug, we love that
We intentionally train our pharmacists to be that point of contact to either start with answering questions or follow up care from a physician
LORI WALSH
What are some of the top questions your pharmacists are telling you they are getting from rural South Dakotans particularly?
JESSICA STROBL
I think right now one of the really common questions is how can I get a GLP-1 covered or how can I get it in the least expensive way?
So, there are a lot of options that we have access to. Some of them include manufacturer coupons and those would be a great option for someone who’s not a Medicare-age patient. Now, with the GLP-1 bridge program starting in July, Medicare patients also have access to lower-cost GLP-1s specifically for weight loss. Not every patient will qualify for that, and our pharmacists are all trained to help a patient navigate if they qualify for that program. That gets them access to a GLP-1 for $50 a month if they qualify, which is a great price for these medications.
So I think that’s a very common question we get currently because of all the news that GLP-1s are getting is just how can I get access? Do I qualify for reduced-cost medications either through commercial insurance or a coupon or potentially through that Medicare bridge program if patients qualify
LORI WALSH
Let’s break that down a little bit if we can. If you have a manufacturer coupon, how long does it last?
JESSICA STROBL
That varies, and you actually don’t necessarily have to walk in with a manufacturer coupon. I would say most pharmacies have access. I know for sure Lewis Drugs have very easy access that when we put the prescription in, we can just click a button to do a search to see are there any manufacturer coupons out there
So if you’re walking in with one or if you aren’t, you still would potentially have access to those coupons, but it definitely varies per manufacturer. For the most part, some of them might do like a very discounted first month trial and then lower costs subsequently after that
Some of them might do, you know, a three-to-six-month trial. So it does vary a lot per product
LORI WALSH
What happens when that time period ends? Do you need physician to prescribe this, first of all, and then, about that trial period … We understand there might be side effects, and you might not continue. But if you do want to continue, without a discount, some of these medications are $1,000 a month
JESSICA STROBL
Yes.
LORI WALSH
So help us parse that out
JESSICA STROBL
Yeah, that’s a really great question, because I think when we first start thinking about who should be on a GLP-1, it really comes down to a lot of different factors. And so we definitely want a physician involved. A pharmacist can certainly look at the entire picture, a patient, what medications they’re on, if there’s going to be any interactions, maybe other disease states, but we do need that prescription to start with the provider’s office. So that’s definitely step one is visiting with your pharmacist or prescriber to get that part initiated.
Then as you start a GLP-1, one of the most important pieces with this particular type of product is a titration up. So that means you have to start on a low dose and then gradually work your way up slowly
And that’s super important with these medications. So that’s why no matter what pharmacy you go to or what provider you’re seeing, if you’re going to start a GLP-1, their first question should be, have you ever been on one prior?
If you’re just starting, you have to start at a low dose. And that’s all about the side effects. These medications do have a lot of GI side effects, meaning like nausea, stomach upset. But if you start low and go slow, is how we explain it, start at a low dose and slowly work your way up, it allows your system to get used to the medication so that you can tolerate them better
So to answer your question, yeah, when you first get started, you’re likely going to be put on a very low starting dose for that titration and that sometimes where those coupons might be is on those starting doses and then gradually work your way up
If you … depending on your coverage … I mean, each coverage is different. And now that the GLP-1 Bridge Program came out for Medicare, it is technically only in effect for now until December 31st, 2027
So that’s the same question Medicare patients are asking is, Great, I have a year and a half of this. What after that? And I do hope that the Medicare system evaluates continuation of this program because we’re finding that weight loss can be such a helpful way to get healthier in other ways besides the cosmetic reason of losing weight
I would say every person is different in terms of their coverage and how we can help them find this in the least expensive way possible
LORI WALSH
For people who are using this for obesity, to treat obesity, their concern, of course, reasonably, would be reports that If I stop taking this, then I’m going to gain back all the weight that I’ve lost
So that’s partially why you’re saying that continued evaluation might be very, very important for those patients as well
JESSICA STROBL
Absolutely. And I’m really glad that you brought that up because one of the ways that GLP-1s work is it triggers our brain to kind of feel full faster. And so, I think it’s really important that when you’re using this type of medication to kind of learn your body and understand what that feels like to feel full because really a lot of it comes down to portion sizes and being healthy. And so I think a lot of people think, Well, right when I stop this, I’m going to gain the weight back
That’s not necessarily true if you’ve been implementing some lifestyle changes along with the medication while you’re on it. So there’s that chance to decrease your portion sizes and continue on with healthy lifestyle modifications after the medication. And some people are able to be successful
The most successful patients on GLP-1s are ones that use the medication, but also make other lifestyle changes
LORI WALSH
What about Medicaid in South Dakota? Is it available for Medicaid patients?
JESSICA STROBL
Currently, it is not, except unless a provider fills out what we call a prior authorization form to prove other health issues
LORI WALSH
Let’s talk a little bit about people going off-market, finding things online, compound pharmacies. Maybe someone has a cousin who’s got some extra. Tell us what can go wrong with that and how to talk to your pharmacist about those sort of choices
JESSICA STROBL
Once again, it’s so important to have the right dose, especially to start. Especially if you’re thinking My friend is using it or I’m just going to use a dose, that’s actually fairly dangerous because if they’re on a higher dose that you’ve never had exposure to and you take that dose as your first dose, high dose, you can actually get very sick
The dose titration is so important, and that’s hard to monitor if you’re just using medication from somewhere else. The compounding piece, there are reputable compounding pharmacies that do make GLP-1
So, I would not do a blanket statement and say that that’s necessarily a bad idea. But I think one of the issues with the GLP-1 boom is just the idea of where is that
Where is that compounding pharmacy getting that product to make it for a patient? And so, it’s really important to make sure you’re using a reputable compounding pharmacy if you’re going that way
LORI WALSH
Talk to me a little bit about the side effects, when you would go back to your pharmacist and say this is what’s happening and not just stop something without checking with the medical provider
JESSICA STROBL
It’s really important to know that when you start on that low dose, those side effects should be lessened. However, they are still possible. So if you had any extreme nausea or vomiting, you would definitely want to take a break and talk to your physician or pharmacist. If you had any low blood sugars, because these medications also help with diabetes, they’re obviously decreasing your blood sugars. So you could get blood sugars that are too low, which can cause some dizziness, sweating, heart palpitations, those kinds of things.
So it’s really important for a patient to know their baseline, start low and go slow like we talked about. And then if they’re having side effects that are not tolerable, letting their physician and pharmacist know that, because sometimes they are able to try a different medication in the same class that they can tolerate better
But once again, it’s a matter of doing that titration. Because we have had some patients that have either missed a dose or didn’t feel good, so skipped a dose or two. Then they try to start back up, and if they start at the latest dose they were at, they can once again have those issues. So even just missing up to three doses, you really have to start again at that really low dose to let your system get used to it
LORI WALSH
So communication is really, really key
JESSICA STROBL
Absolutely. And that’s one thing that I personally —obviously I’m biased — but I think it’s extremely easy to communicate with a pharmacist, not that it’s not with your provider, but once again, pharmacists just being so available that it’s a great re
LORI WALSH
Now, some of these are shots or injectables. How do the pharmacists have to walk people through the process of doing that? Because most people have not given themselves an injection before. There are pills too, as I understand it
JESSICA STROBL
Yes, there are pills as well. They’re fairly new
Really a patient could choose which one they want to start first. Some people, especially if they have an aversion to needles or giving themselves an injection, the tablet is a great start. But sometimes the tablets do have a little more of that stomach upset. So if somebody’s got a sensitive stomach or, you know, prefers to try to decrease those types of side effects, then the injection might be a better choice for them
Injection technique is actually extremely important, similar to insulins. Insulins are also a peptide that are a lot older than the GLP-1s. But because you’re giving this into the fat tissue, we call that a subcutaneous injection because you’re giving that into the fat tissue, you need to make sure to give it correctly so that it stays in that fat tissue
And that’s what’s unique about these prescriptions is that then you just do that once a week. So you inject yourself, it’s staying in that tissue and it’s releasing in your system throughout the week
So if someone comes in with a first time GLP-1 prescription, the Lewis pharmacist will sit down and first, figure out if you know how to use it. Also, make sure that you have the right equipment. What’s kind of confusing about some of these GLP-1s is some of them come with the needles and some of them don’t
Sometimes the provider’s offices kind of forget which one is which, so the pharmacist can help you figure out, is everything that you need right in this box, or are we going to have to send you home with some additional equipment like the needle that you’ll twist on top of that pen. And then we will teach you how to do that safely and cleanly because we want to avoid infections as well. So really important to use a new needle each injection to prevent those infections
LORI WALSH
Anything else that people are asking that you want to get public information out about whether it’s about GLP-1s or something else?
JESSICA STROBL
I think for the most part, what we’re really passionate about at Lewis is just that people know that getting that prescription is the first step in their GLP-1 journey, but it really doesn’t end there
You have that prescription. You have to make sure that you understand how to use it, that you use it correctly and as instructed, and that you’re looking for continued support and evaluating those lifestyle changes as well. I know there’s a lot of different options for patients to get these right now, because like you mentioned, they’re advertised about everywhere
But I’m passionate about people, you know, getting this from the pharmacy so that you can have that continued rerney rather than just get a medication injected and see what happens
We want to be there for you, understand your whole picture, know your goals and help you through that journey
