Medicaid and GLP-1 Medications for Obesity: Limited Coverage and State Initiatives

A recent report by KFF highlighted that as of August 2025, only 13 states had Medicaid programs covering GLP-1 receptor agonists for obesity treatment. South Carolina became the 14th state in November to include these medications in its coverage. Despite this progress, federal policies under the Trump administration have refused to expand Medicaid coverage for GLP-1s specifically for weight management. Liz Williams, a senior policy manager at KFF, noted that no additional states have adopted such coverage since South Carolina, and budget considerations amid potential federal cuts may hinder further adoption.

In contrast, Medicare currently covers GLP-1 medications solely for diabetes and other conditions like sleep apnea and cardiovascular disease, not for obesity. Early in April 2025, the Trump administration announced it would not move forward with a proposed rule by the Biden administration that would allow approximately 7.4 million Medicare and Medicaid beneficiaries to access GLP-1s for weight loss. Additionally, the FDA plans to remove less costly compounded versions of these drugs from the market, potentially increasing costs for patients.

Coverage barriers remain significant even in states like South Carolina, where only a small number of Medicaid beneficiaries—approximately 1,300—qualify due to strict prerequisites such as increased exercise activity. The cost of these drugs is substantial; for instance, Wegovy, produced by Novo Nordisk, lowered its price from $650 to $499 per month for cash customers, but many patients face costs exceeding $1,000 monthly, often requiring ongoing use to sustain weight loss.

States like California and North Carolina are reconsidering their coverage policies due to budget concerns. California's governor proposed eliminating Medicaid coverage for weight loss drugs to save an estimated $680 million annually by 2028. North Carolina's state health plan also voted to cease coverage, citing projected costs of roughly $1 billion over six years.

South Carolina's Medicaid estimates annual spending on GLP-1 medications and related nutrition counseling at $10 million, with federal matching funds covering a significant portion. Health officials express cautious optimism regarding future federal policy changes, with Secretary Robert F. Kennedy Jr. suggesting that as drug costs decrease, coverage for obesity treatment with GLP-1s might expand.

While advocates praise South Carolina’s decision, the majority of the state's obese population—over 1.5 million adults—remains without access to these therapies. Public health experts emphasize the need for a comprehensive approach to obesity, which might include surgical options and medications, balanced against potential risks and costs. Overall, the landscape of GLP-1 coverage for obesity remains complex, marked by policy debates, budget constraints, and evolving medical standards.