Key TakeawaysSome, but not all, state Medicaid programs cover GLP-1 drugs for weight management.Even in states that cover the drugs, there may be certain requirements for coverage, such as a letter from your doctor and participation in an exercise program.

Key Takeaways

Some, but not all, state Medicaid programs cover GLP-1 drugs for weight management.Even in states that cover the drugs, there may be certain requirements for coverage, such as a letter from your doctor and participation in an exercise program.

Two-thirdsof Medicaid beneficiaries have obesity or overweight, but that doesn’t necessarily mean recipients of the government-funded low income insurance program have wider access to new weight management medications.

Only 16 states list glucagon-like peptide (GLP-1) receptor agonists, a newer class of injectable medications used for both diabetes and weight loss, on their covered drug lists,according to a Fall 2023 reportfrom health research firm KFF. The report focused on Medicaid prescriptions for Ozempic, Rybelsus, Wegovy, and Mounjaro (the latter of which is also a GIP receptor antagonist). Of these medications, only Wegovy is technically FDA-indicated for weight loss; the others are type 2 diabetes medications used “off-label” to help patients lose weight.

“From Medicaid data publicly available, there is no way yet to disentangle how much of the growing use of these drugs is related to treatment for diabetes versus obesity, or a combination of both,” the report says.

“State Medicaid programs can cover the injectable drugs, but they don’t have to,”Liz Williams, a senior policy analyst for the Program on Medicaid and the Uninsured at KFF, told Verywell.

Importantly, this is more lenient than Medicare coverage rules, which prohibit the coverage of drugs for obesity or weight loss altogether.

Does Medicare Cover Wegovy?

There’s hope that more states will add Medicaid coverage for anti-obesity medications during the current state legislative session as budgets are discussed,Kate McEvoy,executive director of the National Association of Medicaid Directors, told Verywell.

Each state’s Medicaid website includes a formulary (a list of covered drugs) where you can check if GLP-1 medications—or other weight management drugs—are covered specifically for the indications of obesity, overweight, and/or weight loss.

States With Coverage May Have Specific Rules

In Michigan, Medicare authorization is contingent on a physician’s letter stating that the drug is part of a comprehensive treatment plan for weight management, including diet and exercise.

When it comes to reauthorizing GLP-1 Medicare coverage for someone already taking the medication for weight management, Mississippi, Virginia, and Michigan each require proof of weight maintenance or improvement to indicate the drug is working.

These hurdles exist because state Medicaid budgets can’t afford to cover everyone who would benefit from the drug. While some private insurers charge higher copays to help offset the cost of the drugs, Medicaid copays are capped at no more than $8 for drugs that aren’t on the preferred drug list,Wayne Turner,a senior attorney at the National Health Law Program in Washington, DC, told Verywell.

Ways to Save on Mounjaro and Ozempic

While it could be a while before all state Medicaid programs cover drugs specifically for weight loss, if a GLP-1 is approved for another indication in the meantime, Medicaid would have to cover it for that use in every state—and weight loss could be a side benefit. This recently happened with Wegovy, which earned FDA approval in Marchto reduce the risk of heart attack, stroke, and other cardiovascular problemsin adults with heart disease who have obesity or overweight. Previously, it was only indicated for weight management.

GLP-1 manufacturers are investigating them for other uses, including sleep apnea and treatment of addiction.If the FDA approves those indications, Medicaid will cover them, Turner said.

What This Means For YouIf you are insured through Medicaid, check your state’s formulary to see if GLP-1 medications are covered. It’s important to know that coverage can change every year. Just because Wegovy is covered in 2024 doesn’t mean it will be in 2025, especially if drugs that are cheaper or more effective become available.

What This Means For You

If you are insured through Medicaid, check your state’s formulary to see if GLP-1 medications are covered. It’s important to know that coverage can change every year. Just because Wegovy is covered in 2024 doesn’t mean it will be in 2025, especially if drugs that are cheaper or more effective become available.

3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Milliman.GLP-1 agonists in Medicaid: utilization, growth and management.Le KDR, Le K, Foo F.The impact of glucagon-like peptide 1 receptor agonists on obstructive sleep apnoea: a scoping review.Pharmacy (Basel). 2024;12(1):11. doi:10.3390/pharmacy12010011Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A.The role of glucagon-like peptide 1 (GLP-1) in addictive disorders.Br J Pharmacol. 2022;179(4):625-641. doi:10.1111/bph.15677

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Milliman.GLP-1 agonists in Medicaid: utilization, growth and management.Le KDR, Le K, Foo F.The impact of glucagon-like peptide 1 receptor agonists on obstructive sleep apnoea: a scoping review.Pharmacy (Basel). 2024;12(1):11. doi:10.3390/pharmacy12010011Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A.The role of glucagon-like peptide 1 (GLP-1) in addictive disorders.Br J Pharmacol. 2022;179(4):625-641. doi:10.1111/bph.15677

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Milliman.GLP-1 agonists in Medicaid: utilization, growth and management.Le KDR, Le K, Foo F.The impact of glucagon-like peptide 1 receptor agonists on obstructive sleep apnoea: a scoping review.Pharmacy (Basel). 2024;12(1):11. doi:10.3390/pharmacy12010011Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A.The role of glucagon-like peptide 1 (GLP-1) in addictive disorders.Br J Pharmacol. 2022;179(4):625-641. doi:10.1111/bph.15677

Milliman.GLP-1 agonists in Medicaid: utilization, growth and management.

Le KDR, Le K, Foo F.The impact of glucagon-like peptide 1 receptor agonists on obstructive sleep apnoea: a scoping review.Pharmacy (Basel). 2024;12(1):11. doi:10.3390/pharmacy12010011

Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A.The role of glucagon-like peptide 1 (GLP-1) in addictive disorders.Br J Pharmacol. 2022;179(4):625-641. doi:10.1111/bph.15677

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