States Drop Medicaid Coverage for GLP-1 Weight-Loss Drugs as Demand Surges

Four US states—California, New Hampshire, Pennsylvania, and South Carolina—ended Medicaid coverage for GLP-1 weight-loss drugs on January 1, with three more states considering similar restrictions, as rising costs threaten public healthcare budgets. California projected its GLP-1 coverage costs would quadruple to nearly $800 million annually, prompting the cut despite having covered weight loss drugs since 2006 and serving over 645,000 GLP-1 prescriptions by 2024. The coverage cuts proceed even after the Trump administration announced negotiated price reductions in November that would lower Wegovy costs to $245 per month for government programs, down from a $1,350 list price. Medical experts warn that discontinuing the drugs will harm patients who typically regain weight after stopping treatment, while out-of-pocket costs remain prohibitive for most Medicaid recipients despite new pricing, with about 1 in 8 adults now taking GLP-1 medications.

States Ending Medicaid Coverage for GLP-1 Weight-Loss Drugs

• ▪More than 645,000 GLP-1 prescriptions were covered by Medi-Cal across all uses of the medications by 2024
• ▪New Hampshire ended Medicaid coverage for adult GLP-1 prescriptions for obesity on January 1
• ▪California projected its costs to cover GLP-1s for weight loss would have more than quadrupled over four years to nearly $800 million annually without ending Medi-Cal coverage
• ▪California, New Hampshire, Pennsylvania, and South Carolina continue to cover GLP-1 drugs for Type 2 diabetes, cardiovascular disease, and chronic kidney disease
• ▪North Carolina pulled back GLP-1 coverage in October
• ▪California ended Medi-Cal coverage for GLP-1 weight loss drugs on January 1
• ▪North Carolina Governor Josh Stein reinstated GLP-1 coverage in December after court orders
• ▪Sixteen states covered GLP-1 medications for obesity as of October 1

Trump Administration's Price Reduction Plan and State Response

• ▪The White House announced negotiated price reductions for GLP-1 drugs in November that would make the drugs available at a dramatically lower cost to taxpayers
• ▪Medicare and Medicaid programs will pay $245 per month for Wegovy under the Trump administration's TrumpRx plan
• ▪The Trump administration's TrumpRx online portal will offer Wegovy at $350 per month for consumers versus the current list price of nearly $1,350

Medical Concerns About Discontinuing GLP-1 Treatment

• ▪Wilmer Cardenas of Santa Clara said his husband Jeffer Jimenez lost about 100 pounds over about two years using GLP-1s covered by Medi-Cal
• ▪Over half of GLP-1 users said their medications were difficult to afford according to KFF poll results released in November

Alternative Options and Coverage Exceptions for Patients

• ▪The FDA approved a pill version of Wegovy on December 22
• ▪The pill version of Wegovy will likely cost $149 per month for the lowest dosage

Perspective of Medical professionals treating obesity

• ▪Diana Thiara of UCSF Weight Management Program said discontinuing GLP-1 drugs will be quite negative for patients because data shows people typically regain weight after stopping the drugs.

Perspective of Medicaid patients using GLP-1 drugs for weight loss

• ▪Over half of GLP-1 users said their medications were difficult to afford according to KFF poll results released in November
• ▪Wilmer Cardenas of Santa Clara said his husband Jeffer Jimenez lost about 100 pounds over about two years using GLP-1s covered by Medi-Cal