![\"Boxes](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/11\/Ozempic-weight-loss.jpg\")
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Boxes of the diabetes drug Ozempic rest on a pharmacy counter in Los Angeles. Drugs like Ozempic have grown in popularity to treat obesity, prompting more than a dozen states to pay for them. But with major budget pressures, several state Medicaid agencies are either stopping coverage altogether or restricting who can get access to the therapy (Mario Tama\/Getty Images).<\/p>\n
Some states are rethinking their coverage of GLP-1 drugs for weight loss as budgets tighten and Medicaid programs brace for the cuts included in President Donald Trump\u2019s broad tax and spending law.<\/p>\n
As of Oct. 1, 16 state Medicaid programs<\/a> covered GLP-1s for obesity treatment, up from 13 last year, according to a survey of Medicaid directors by KFF, a health policy research group. But some states have announced they will discontinue coverage or restrict who can qualify for it.<\/p>\n Many doctors and patient advocates say the drugs will save money in the long run by reducing obesity-related diseases such as heart disease and diabetes. Many states, however, have concluded they just can\u2019t afford them.<\/p>\n North Carolina Medicaid ended coverage of GLP-1s<\/a> for obesity last month, citing shortfalls in state funding. California, New Hampshire and South Carolina have said they will end coverage on Jan. 1. Starting next year, Michigan Medicaid will limit coverage to people who are \u201cmorbidly obese.\u201d Pennsylvania, Rhode Island and Wisconsin also are considering new restrictions.<\/p>\n In last year\u2019s KFF survey, about half the states said they were interested in covering GLP-1s for weight loss, according to Elizabeth Williams, a senior policy manager at KFF who focuses on Medicaid. This year, most states are moving in the opposite direction.<\/p>\n This likely reflects recent state budget challenges and the significant, significant costs associated with coverage.<\/p>\n<\/div>\n \u2013 Elizabeth Williams, KFF senior policy manager<\/b><\/p>\n<\/div>\n<\/div>\n<\/div>\n \u201cThis likely reflects recent state budget challenges and the significant, significant costs associated with coverage,\u201d Williams said. \u201cAfter a number of years of robust revenue growth right after the pandemic, states are starting to see slowing revenues, increasing spending demands and a lot of fiscal uncertainty due in part to recent federal actions.\u201d<\/p>\n In April, the Trump administration scrapped<\/a> a Biden-era proposal that would have required state Medicaid programs to pay for some GLP-1s for obesity treatment. Earlier this month, Trump announced <\/a>that his administration had reached agreements with the manufacturers of Wegovy and Zepbound to reduce the prices of the drugs for Medicaid, Medicare and consumers buying the drugs directly, But it\u2019s unclear whether the deals will reduce costs for states<\/a>.<\/p>\n Health plans for state workers also are reassessing their coverage of the drugs for obesity. North Carolina, for example, ended GLP-1 obesity coverage for state workers last year, and West Virginia canceled a 1,000-person pilot program.<\/p>\n GLP-1 medications, which balance blood sugar levels, have long been prescribed to patients with Type 2 diabetes and cardiovascular conditions. All state Medicaid programs, which are funded jointly by the states and the federal government, cover GLP-1s for those uses.<\/p>\n But the drugs also curb hunger signals and can help people lose significant amounts of weight. Medications such as Ozempic, Wegovy and Zepbound have become wildly popular for that purpose.<\/p>\n Between 2019 and 2023, the number of outpatient Medicaid prescriptions for select GLP-1s to treat diabetes and obesity grew from 755,300 to 3.8 million, according to KFF<\/a>. During the same period, Medicaid spending on those drugs increased from $597.3 million to $3.9 billion.<\/p>\n A study published last year<\/a> in The BMJ, the journal of the British Medical Association, found that the number of patients without diabetes who started GLP-1 treatment in the United States increased from roughly 21,000 in 2019 to 174,000 in 2023, or more than 700%.<\/p>\n More than 2 in 5 U.S. adults<\/a> have obesity, according to the federal Centers for Disease Control and Prevention. The CDC defines obesity as having a body mass index \u2014 a calculated measure of body weight relative to height \u2014 of 30 or higher. Obesity costs the U.S. health care system almost $173 billion per year, according to the agency.<\/p>\n Recently, the manufacturers of some GLP-1s have lowered their prices<\/a>, selling them directly to consumers for $500 or less per month. But many patients cannot afford to pay that much out of pocket.<\/p>\n In North Carolina, Dr. Jennifer McCauley, a weight management physician at UNC Health, said Medicaid coverage of GLP-1s was \u201cincredibly helpful for our patients.\u201d<\/p>\n \u201cNow they\u2019ve stopped coverage, so those people are now going back, regaining some of the weight, because they\u2019re unable to obtain these medications, and also are suffering the health consequences of obesity,\u201d McCauley told Stateline.<\/p>\n Some critics of expansive GLP-1 coverage say it isn\u2019t cost effective<\/a>, because many patients gain back the weight they lost when they stop treatment. But McCauley said the \u201cdownstream effects of obesity are even higher.\u201d<\/p>\n \u201cThere are definitely vulnerable populations that probably would not be able to obtain weight loss without these medications.\u201d<\/p>\n James Werner, a spokesperson at the North Carolina Department of Health and Human Services, blamed the coverage change on the state legislature\u2019s failure to budget enough money for Medicaid.<\/p>\n In an email to Stateline, Werner said coverage of GLP1s for weight loss \u201cwould be reconsidered if Medicaid is fully funded.\u201d<\/p>\n Some states are trying to maintain at least some coverage of the expensive drugs by tightening the eligibility requirements for a prescription, according to Colleen Becker, a project manager at the National Conference of State Legislatures, a policy research group.<\/p>\n \u201cStates are really looking at how to balance access and provide that access to patients, but they\u2019re stewards of their budgets, and they need to be good stewards of it,\u201d Becker said.<\/p>\n Michigan and Pennsylvania are among the states considering such options. Meanwhile, Connecticut has decided to maintain coverage of weight-loss drugs for state employees, but to require beneficiaries to try online weight-loss counseling before they can get a prescription.<\/p>\n One state, North Dakota, has taken a different approach to GLP-1 coverage after legislation that would have required the state\u2019s Medicaid<\/a> program to cover the drug failed. Instead, North Dakota this year became the first state to mandate that insurers on the state\u2019s Affordable Care Act marketplace cover the drugs for weight loss.<\/p>\n North Dakota Deputy Insurance Commissioner John Arnold said the insurance department calculated that the mandate wouldn\u2019t cause insurance premiums to rise significantly.<\/p>\n \u201cIt\u2019s not that anybody can walk into the doctor\u2019s office and say, \u2018Hey, I want to have this covered,\u2019\u201d Arnold said. \u201cIt is really for those who have a medical need for the drugs, then it would be covered.\u201d<\/p>\n The insurance department had to ask the legislature for permission to make the change, according to North Dakota Republican House Speaker Robin Weisz. He said insurance carriers were concerned that it was going to be \u201copen season for everybody who could lose 20 or 30 pounds.\u201d<\/p>\n He said it will take time to see whether the policy raises insurance premiums.<\/p>\n \u201cIf the carriers can come in a couple years and say, \u2018Wow, here\u2019s what we\u2019ve spent on these \u2026 we\u2019ll take a hard look at it,\u201d Weisz said. \u201cBut, it\u2019s way too early to tell at this point.\u201d<\/p>\n Arnold says other states may have the flexibility to consider mandating ACA insurers to cover the drugs.<\/p>\n \u201cOur biggest concern was reducing those comorbidities and the long-term impact that that has on the cost of insurance in general, because more comorbidities means more claims,\u201d Arnold said, referring to diseases and conditions associated with obesity.<\/p>\n Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org<\/a>.<\/em><\/p>\n\n\n<\/div>\n\n\nStates in a tough financial position<\/h4>\n
Some future possibilities<\/h4>\n