Medicaid coverage policy and variation in GLP-1RA spending: State-level patterns and policy impacts
Description
Background: GLP-1 receptor agonists (GLP-1RAs) are reshaping obesity and type 2 diabetes (T2D) management, yet affordability and coverage, particularly in Medicaid, remain contentious. While most states cover GLP-1RAs for T2D, coverage for obesity varies widely, leading to differences in prescribing and spending.
Research Objective: To quantify how Medicaid coverage policies for obesity treatment affect GLP-1RA utilization and spending across all 50 states and the District of Columbia from Q1-2023 to Q4-2024.
Methods: We conducted a retrospective analysis using CMS State Drug Utilization Data (quarterly) and CMS Medicaid/CHIP enrollment files. All GLP-1RAs approved for obesity or T2D were included. Outcomes were (1) prescriptions per 1,000 enrollees and (2) spending per enrollee. States were grouped into three policy categories based on obesity coverage. Data were aggregated into state-quarters. Calculations were performed in R (RStudio); IRB review was not required.
Results: States covering GLP-1s for both diabetes and weight loss (n = 13) had the largest increases. Prescriptions rose from 9.8 to 34.4 per 1,000 enrollees, with spending per enrollee increasing from $10.65 to $36.83. States covering obesity but not GLP-1RAs (n = 4) had smaller increases, while states that do not cover obesity treatments (n = 33 + DC) had the lowest change. By Q4-2024, GLP-1 utilization varied widely. Median prescribing was 17 per 1,000 (IQR: 8.9–29.9), with median spending ranging from $8.08 to $27.71.
Conclusion: Coverage policies shape access and drive Medicaid spending trends. States covering GLP-1RAs for obesity face markedly higher costs but offer broader access to treatment.
Citation Information
William, Mina and Devine, Joshua, "Medicaid coverage policy and variation in GLP-1RA spending: State-level patterns and policy impacts" (2026). Office of Research DMU Research Symposium. 7.
https://digitalcommons.dmu.edu/researchsymposium/2025rs/2025abstracts/7
Medicaid coverage policy and variation in GLP-1RA spending: State-level patterns and policy impacts
Background: GLP-1 receptor agonists (GLP-1RAs) are reshaping obesity and type 2 diabetes (T2D) management, yet affordability and coverage, particularly in Medicaid, remain contentious. While most states cover GLP-1RAs for T2D, coverage for obesity varies widely, leading to differences in prescribing and spending.
Research Objective: To quantify how Medicaid coverage policies for obesity treatment affect GLP-1RA utilization and spending across all 50 states and the District of Columbia from Q1-2023 to Q4-2024.
Methods: We conducted a retrospective analysis using CMS State Drug Utilization Data (quarterly) and CMS Medicaid/CHIP enrollment files. All GLP-1RAs approved for obesity or T2D were included. Outcomes were (1) prescriptions per 1,000 enrollees and (2) spending per enrollee. States were grouped into three policy categories based on obesity coverage. Data were aggregated into state-quarters. Calculations were performed in R (RStudio); IRB review was not required.
Results: States covering GLP-1s for both diabetes and weight loss (n = 13) had the largest increases. Prescriptions rose from 9.8 to 34.4 per 1,000 enrollees, with spending per enrollee increasing from $10.65 to $36.83. States covering obesity but not GLP-1RAs (n = 4) had smaller increases, while states that do not cover obesity treatments (n = 33 + DC) had the lowest change. By Q4-2024, GLP-1 utilization varied widely. Median prescribing was 17 per 1,000 (IQR: 8.9–29.9), with median spending ranging from $8.08 to $27.71.
Conclusion: Coverage policies shape access and drive Medicaid spending trends. States covering GLP-1RAs for obesity face markedly higher costs but offer broader access to treatment.
