Editor's Note: This story originally appeared on Real Chemistry.
The growing popularity of GLP-1 receptor agonists — drugs that include Ozempic and Wegovy from Novo Nordisk, and Mounjaro and Zepbound from Eli Lilly — has added fuel to an already fiery debate over the government’s role in subsidizing access to these drugs.
Originally developed for Type 2 diabetes, these medications have proven highly effective for treating obesity — a chronic condition affecting more than 40% of U.S. adults. However, with costs often exceeding $1,000 per month for patients who are under- or uninsured, these treatments remain out of reach for many Americans.
Medicare currently limits its coverage of GLP-1s to individuals with Type 2 diabetes or certain heart conditions, excluding prescriptions aimed solely at obesity. However, coverage for obesity of GLP-1s by Medicaid, a joint federal and state program for people with limited income, varies by state.
While Medicaid programs in all states include GLP-1s prescribed for Type 2 diabetes, only 36 states cover at least one of the FDA-approved GLP-1s for obesity (Wegovy, Zepbound, or Saxenda).
Experts at Real Chemistry examined which states’ Medicaid programs currently cover GLP-1s approved to treat obesity and how much they are spending. Learn more about the methodology at the end.
Here are the state Medicaid programs spending the most on weight loss drugs.
15. West Virginia
- Medicaid spending on GLP-1s (past 12 months): $47,581,939
- Medicaid spending on GLP-1s (YoY change): +47%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $100
- Total Medicaid enrollment: 476,150
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
14. Louisiana
- Medicaid spending on GLP-1s (past 12 months): $52,199,620
- Medicaid spending on GLP-1s (YoY change): +36%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $38
- Total Medicaid enrollment: 1,375,785
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
13. New Jersey
- Medicaid spending on GLP-1s (past 12 months): $52,647,057
- Medicaid spending on GLP-1s (YoY change): +264%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $34
- Total Medicaid enrollment: 1,557,771
- Wegovy coverage (obesity-indicated): No
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): No
- Rybelsus coverage (Type 2 diabetes-indicated): No
12. Indiana
- Medicaid spending on GLP-1s (past 12 months): $53,603,387
- Medicaid spending on GLP-1s (YoY change): +42%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $33
- Total Medicaid enrollment: 1,635,463
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
11. Tennessee
- Medicaid spending on GLP-1s (past 12 months): $59,956,696
- Medicaid spending on GLP-1s (YoY change): +57%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $46
- Total Medicaid enrollment: 1,294,456
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
10. Connecticut
- Medicaid spending on GLP-1s (past 12 months): $64,096,414
- Medicaid spending on GLP-1s (YoY change): +193%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $70
- Total Medicaid enrollment: 921,207
- Wegovy coverage (obesity-indicated): No
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): No
- Rybelsus coverage (Type 2 diabetes-indicated): No
9. Wisconsin
- Medicaid spending on GLP-1s (past 12 months): $65,021,934
- Medicaid spending on GLP-1s (YoY change): +315%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $58
- Total Medicaid enrollment: 1,117,764
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
8. Ohio
- Medicaid spending on GLP-1s (past 12 months): $65,938,648
- Medicaid spending on GLP-1s (YoY change): +26%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $25
- Total Medicaid enrollment: 2,650,284
- Wegovy coverage (obesity-indicated): No
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
7. Maryland
- Medicaid spending on GLP-1s (past 12 months): $68,451,047
- Medicaid spending on GLP-1s (YoY change): +86%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $50
- Total Medicaid enrollment: 1,380,152
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
6. Minnesota
- Medicaid spending on GLP-1s (past 12 months): $70,744,653
- Medicaid spending on GLP-1s (YoY change): +420%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $61
- Total Medicaid enrollment: 1,168,269
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
5. New York
- Medicaid spending on GLP-1s (past 12 months): $178,193,836
- Medicaid spending on GLP-1s (YoY change): +57%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $30
- Total Medicaid enrollment: 6,026,269
- Wegovy coverage (obesity-indicated): No
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
4. Michigan
- Medicaid spending on GLP-1s (past 12 months): $190,299,664
- Medicaid spending on GLP-1s (YoY change): +108%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $87
- Total Medicaid enrollment: 2,186,478
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
3. Kentucky
- Medicaid spending on GLP-1s (past 12 months): $204,109,709
- Medicaid spending on GLP-1s (YoY change): +38%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $162
- Total Medicaid enrollment: 1,263,493
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): No
- Saxenda coverage (obesity-indicated): No
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
2. Pennsylvania
- Medicaid spending on GLP-1s (past 12 months): $297,757,658
- Medicaid spending on GLP-1s (YoY change): +232%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $106
- Total Medicaid enrollment: 2,811,235
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
1. California
- Medicaid spending on GLP-1s (past 12 months): $1,437,053,280
- Medicaid spending on GLP-1s (YoY change): +235%
- Medicaid spending on GLP-1s per enrollee (past 12 months): $118
- Total Medicaid enrollment: 12,209,342
- Wegovy coverage (obesity-indicated): Yes
- Zepbound coverage (obesity-indicated): Yes
- Saxenda coverage (obesity-indicated): Yes
- Ozempic coverage (Type 2 diabetes-indicated): Yes
- Mounjaro coverage (Type 2 diabetes-indicated): Yes
- Rybelsus coverage (Type 2 diabetes-indicated): Yes
Methodology
The data used in this study comes from IRIS by Real Chemistry — a proprietary market intelligence platform fueled by billions of data points, including medical, hospital, and pharmacy claims covering more than 300 million U.S. patients over 10 years. Additional statistics on Medicaid enrollment were sourced from the Centers for Medicare & Medicaid Services.
For this analysis, GLP-1 Medicaid spending is the estimated amount of money in U.S. dollars that Medicaid has spent on the most common GLP-1s (Ozempic, Mounjaro, Rybelsus, Saxenda, Wegovy, and Zepbound).
Although Ozempic, Mounjaro, and Rybelsus are not FDA-approved for obesity treatment, they are included in the analysis due to the high number of patients with an obesity diagnosis using these products compared to other FDA-approved Type 2 diabetes GLP-1 agonists.
That said, spending on Ozempic, Mounjaro, and Rybelsus is only included for patients who have an obesity diagnosis; whereas, spending on Saxenda, Wegovy, and Zepbound is included regardless of diagnostic obesity claims.
States were ranked based on total Medicaid spending on these GLP-1 drugs between Nov. 1, 2023, and Oct. 31, 2024. Note that spending totals are estimates generated by comparing previous government data figures from Medicaid’s State Drug Utilization Database to real-time claims data.
State-level Medicaid coverage indicates whether an individual state includes obesity-indicated GLP-1s (Saxenda, Wegovy, and Zepbound) or Type 2 diabetes-indicated GLP-1s (Ozempic, Mounjaro, and Rybelsus) on its formulary or preferred drug list, including non-preferred or restricted coverage.
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