The skyrocketing cost of popular weight-loss drugs like Wegovy, Ozempic, and Zepbound is putting serious pressure on state Medicaid budgets, forcing lawmakers across the country to consider major changes to coverage policies.
Drugs in the GLP-1 class, originally developed for diabetes treatment, have gained widespread popularity for helping patients lose significant weight. But with an average annual cost of $12,000 per patient, these medications are quickly straining public healthcare systems.
Medicaid Budgets Feeling the Pinch
Pennsylvania, for instance, is expecting to spend $1.3 billion on GLP-1 drugs in 2025 alone — a dramatic jump from just a few years ago. The growing expense is contributing to a projected multi-billion-dollar deficit. Officials are exploring ways to control costs, including requiring Medicaid patients to try cheaper treatments or meet a minimum body mass index (BMI) before being approved for the drugs.
“It’s a medication that’s gotten a lot of hype and it’s wildly expensive,” said Dr. Val Arkoosh, Pennsylvania’s human services secretary.
States React with Mixed Policies
At least 14 states currently cover these medications for obesity under Medicaid, and several more are debating similar laws. For example, Arkansas is considering a bill to require Medicaid coverage for GLP-1s when prescribed for weight loss, while Iowa lawmakers want a cost-benefit analysis before making a final decision.
Other states, like West Virginia and North Carolina, have already ended GLP-1 coverage for state employees due to budget concerns. In Connecticut, officials may end Medicaid coverage for weight-loss-related GLP-1 prescriptions altogether.
“It is very expensive,” said Jeffrey Beckham, Connecticut’s budget director.
A report by the KFF nonprofit shows that Medicaid spending on GLP-1 drugs rose from $577 million in 2019 to nearly $4 billion in 2023, driven by a 400% increase in prescriptions.
Medicare Exclusion and Political Tension
While many support expanding access to these drugs, federal policy remains limited. A recent AP-NORC poll found that about half of Americans support Medicaid and Medicare covering weight-loss drugs, though Medicare currently does not. A Biden-era proposal to include GLP-1s under Medicare’s Part D prescription coverage was scrapped by the Trump administration, citing high costs — up to $35 billion over the next decade.
States Try to Manage Costs with Conditions
Some states that continue offering GLP-1 coverage are trying to reduce expenses by limiting who qualifies. In Connecticut, for example, Medicaid patients will soon need a Type 2 diabetes diagnosis to receive the drugs. Gov. Ned Lamont is pushing to instead cover less expensive oral medications approved for weight loss, along with nutrition counseling.
Real-Life Impact on Patients
The coverage cuts are having a real impact. Sarah Makowicki, 42, said GLP-1 drugs — combined with weight-loss surgery — helped her lose over 200 pounds and drastically improved her quality of life.
“I am a different person from what I was five years ago — not only physically, but mentally,” she said.
Sara Lamontagne, a disabled transgender woman on Medicaid, said her denied prescription refill for Ozempic caused her to gain back over 40 pounds. “It’s a horrible game to be played,” she said, frustrated by the back-and-forth in coverage.
The Bigger Picture
Roughly 40% of U.S. adults are living with obesity, according to the CDC, and the condition is linked to serious health problems like high blood pressure, diabetes, and heart disease. Many believe that long-term access to GLP-1 drugs could improve public health and reduce overall healthcare costs — but it’s still unclear how long patients need to stay on these medications for lasting results.
“Someone may have to be on treatment for the rest of their life,” said Tracy Zvenyach from Obesity Action. “But we don’t yet know what that regimen looks like.”
As Medicaid budgets tighten and health outcomes hang in the balance, states are left with tough decisions on how to provide effective obesity care without breaking the bank.
