States across the U.S. are grappling with the increasing costs of popular weight-loss medications like Wegovy, Ozempic, and Zepbound. These GLP-1 drugs, initially prescribed for diabetes, have become widely used for weight loss, putting a strain on state Medicaid programs.
In Pennsylvania, the cost of covering these drugs through Medicaid is expected to hit $1.3 billion in 2025. This sharp increase, compared to previous years, is contributing to a projected multibillion-dollar budget deficit. In response, the state is considering requiring Medicaid patients who want to use GLP-1s for weight loss to meet certain body mass index (BMI) criteria or try cheaper alternatives first.
“It’s a medication that’s gotten a lot of hype and become very popular, but it is incredibly expensive,” said Dr. Val Arkoosh, Pennsylvania’s human services secretary, during a state House hearing in March.
At least 14 states currently cover the cost of these drugs for obesity treatment under Medicaid. Meanwhile, lawmakers in several other states, including Arkansas and Iowa, are proposing bills to extend similar coverage. However, some states like West Virginia and North Carolina have already stopped covering these drugs for state employees due to rising costs.
“This is very expensive,” said Jeffrey Beckham, Connecticut’s state budget director. He added that other states and private insurance providers are reaching similar conclusions.
From 2019 to 2023, Medicaid spending on GLP-1 drugs surged from $577.3 million to $3.9 billion. The number of prescriptions for these medications has increased by more than 400%. On average, the cost per patient is about $12,000 annually, according to a Peterson-KFF tracker.
A recent AP-NORC poll found that nearly half of Americans support Medicaid and Medicare covering weight-loss drugs for those with obesity, though opinions vary. Medicare does not currently cover GLP-1 medications, and the Trump administration recently blocked a proposed rule to include them under Medicare’s Part D prescription drug coverage, citing the high cost. This could have cost taxpayers up to $35 billion over the next decade.
Some states that do provide coverage have implemented prescribing limits to manage costs. There is also evidence suggesting that Medicaid patients who lose weight with these drugs may reduce future healthcare costs. However, concerns remain about whether patients will need to stay on these medications long-term.
Tracy Zvenyach, of Obesity Action, emphasized that the long-term treatment plan for these medications is still uncertain. “Someone may need to stay on treatment for a lifetime,” she said. “But we don’t know exactly what that regimen would look like.”
Obesity is a significant public health issue, affecting about 40% of U.S. adults, according to the Centers for Disease Control and Prevention. It can lead to conditions such as hypertension, Type 2 diabetes, and high cholesterol, increasing the risk of heart disease and stroke.
Dr. Adam Raphael Rom, a physician in Philadelphia, said many of his Medicaid patients use GLP-1 drugs for weight loss. He recounted one patient who lost 60 pounds, describing how the medication changed her relationship with food.
However, experts caution that not everyone experiences significant weight loss. A survey of state Medicaid directors revealed that cost and potential side effects are key concerns when deciding whether to continue coverage for these drugs.
The debate comes at a time when Medicaid budgets are growing, and there are concerns about potential cuts in federal funding. Congressional Republicans are considering reducing Medicaid funding by up to $880 billion over the next decade.
In Connecticut, which is facing a $290 million Medicaid deficit, Governor Ned Lamont has proposed removing the requirement that Medicaid cover GLP-1s for severe obesity. However, starting June 14, Medicaid patients will need a Type 2 diabetes diagnosis to receive coverage for these medications. Lamont is also pushing for coverage of less expensive oral weight-loss drugs and nutrition counseling.
Sarah Makowicki, a 42-year-old student, has struggled with side effects from other weight-loss medications. She is working on a bill to restore full GLP-1 coverage for herself and others. Similarly, Sara Lamontagne, a transgender woman on Medicaid, regained weight after her coverage for GLP-1s was cut. “It’s a horrible game to be played,” she said, reflecting on her unsuccessful attempt to appeal the denial of her Ozempic prescription.
Makowicki, who lost over 200 pounds through a combination of GLP-1 drugs and weight-loss surgery, said the medication has been life-changing. “I am a different person from what I was five years ago,” she said.
This ongoing debate underscores the complexities states face in balancing healthcare costs with providing necessary treatments to their residents.
