Faced with high demand for GLP-1 drugs, some American cities and states that previously covered the cost of the weight-loss medication for low-income residents and public employees have now started to restrict or eliminate coverage.<\/p>\n
The pullback stems from the dramatic increase in public spending on drugs such as Ozempic and Wegovy in recent years.<\/p>\n
Still, some legislators and healthcare providers argue that dropping coverage of the drugs might provide short-term relief for governments but will ultimately harm Medicaid recipients\u2019 health. They argue that cities and states will then have to pay for more health problems related to obesity.<\/p>\n
\u201cPatients should have access to these therapies,\u201d said Dr Matthew Klebanoff, assistant professor of internal medicine at the Perelman School of Medicine who has studied prior authorization policies for GLP-1 drugs. \u201cIt\u2019s just very challenging right now for payers to be able to afford covering these medications for everyone who could benefit.\u201d<\/p>\n
The obesity rate in the United States among adults was 40% in August 2023, according to the Centers for Disease Control and Prevention<\/a>. In November 2025, 12% of adults reported that they were taking a GLP-1 drug \u2013 a 6% increase from 18 months earlier, KFF reported<\/a>. Those drugs have contributed to a decrease in the country\u2019s obesity rate, which fell to 37% in 2025, according to a Gallup report<\/a>.<\/p>\n But that progress has been expensive. In 2018, the country spent $13.7bn on GLP-1 drugs. In 2023, that number was $71.7bn, a 500% increase, according to a report<\/a> in the medical journal Jama.<\/p>\n Sixteen state Medicaid programs \u2013 the federal and state initiative that provides free health insurance to low-income people \u2013 covered the drugs for obesity in October 2025 (though, notably, most states cover GLP-1 drugs for diabetes). As of January this year, California, New Hampshire, Pennsylvania and South Carolina ended Medicaid GLP-1 drug coverage for weight loss, and Michigan started restricting coverage to people classified as morbidly obese, meaning they have a body mass index above 40. Rhode Island\u2019s governor has also proposed<\/a> ending coverage of the drugs.<\/p>\n New York City\u2019s health insurer stopped covering<\/a> GLP-1 drugs for city employees in 2025 while Boston\u2019s leaders are considering limiting<\/a> such coverage for city employees because of an insurance rate hike largely driven by the GLP-1 drug cost.<\/p>\n Many states are also facing a budget crunch due to Donald Trump\u2019s One Big Beautiful Bill Act, which will cut state Medicaid funding by $665bn over the next decade.<\/p>\n \u201cI imagine any state that is covering these medications is having conversations about whether they will be able to continue,\u201d Klebanoff said.<\/p>\n For context, Medicaid spending on GLP-1 drugs in Pennsylvania was $1.3bn in 2025 – a whopping twice as much<\/a> as the previous year.<\/p>\n During budget discussions last year, the state department of human services secretary, Val Arkoosh, said<\/a> Pennsylvania was considering the cuts \u201cto ensure the medications are used appropriately by those who need it most, while considering cost effectiveness by limiting access based on body mass index or other health factors\u201d.<\/p>\n A spokesperson for the department stated in an email to the Guardian that the state had cut some coverage because of an \u201cunsustainable rise in costs from GLP-1s\u201d.<\/p>\n The Medicaid program now in Pennsylvania only covers<\/a> GLP-1 drugs for people with diabetes or those who meet a narrower set of criteria, such as those with sleep apnea and a body mass index of at least 35.<\/p>\n The Pennsylvania state representative Arvind Venkat, a physician, said the state was \u201cessentially allowing people to be much sicker than they should be before we allow them to have access to a medication which has been shown to be safe\u201d.<\/p>\n Alexa Canciello, a 23-year-old with autism, lives with her parents outside Pittsburgh and had a weight problem for years because her brain doesn\u2019t \u201cknow when to shut off the hunger drive\u201d, her father Rich said.<\/p>\n About a year ago, Canciello, a Medicaid recipient, started taking the GLP-1 drug Zepbound. Rich said his daughter lost almost 30lb, noting: \u201cThese GLP-1s, they are miracle workers.\u201d<\/p>\n But the state stopped covering Zepbound for Canciello in January. Without insurance, injections of it cost more than $400 each month, Rich said. Her doctor instead prescribed a pill form of Wegovy, which costs less but has not been as effective for Canciello, who has regained weight, Rich said.<\/p>\n \u201cThere are a lot of people out there that could probably lose weight without GLP-1 drugs if they just discipline themselves and exercise more, but there is a segment of the population that cannot lose weight, and my daughter Alexa unfortunately falls within that category,\u201d Rich said.<\/p>\n Venkat, a Democrat, has introduced legislation<\/a> to create a subscription model for GLP-1 drugs in which the state could enter \u201cvalue-based arrangements with drug manufacturers through supplemental rebate agreements\u201d.<\/p>\n