The recent decision by some US states to cover glucagon-like peptide-1 (GLP-1) agonists for obesity treatment marks a shift in public health policy, yet access to these drugs remains far from widespread.
While medications like Wegovy offer new hope for patients struggling with obesity, stringent eligibility requirements and high costs continue to restrict availability for millions.
Medicaid coverage of GLP-1s for weight loss has been adopted by a small number of states, with South Carolina joining this group most recently in late 2024. However, the federal government has not extended similar benefits to Medicare or Medicaid nationwide, creating uneven access.
State-Level Medicaid Expansions Face Financial and Procedural Hurdles
South Carolina’s Medicaid program began covering GLP-1 drugs for obesity in late 2024, joining 13 other states that provide this benefit. According to a report by KFF Health News, many states remain cautious about adopting coverage for these medications due to their high cost and the uncertain federal budget outlook.
For example, South Carolina anticipates spending around $10 million annually on GLP-1s and associated nutrition counselling, with a significant portion funded through federal matching.
The process to qualify for GLP-1 coverage under Medicaid is rigorous. Patients like Page Campbell, a South Carolina resident, must demonstrate prior unsuccessful weight loss attempts, including documented nutritional counselling and adherence to specific diet and exercise regimens.
Approval periods are limited, requiring ongoing evidence of weight loss progress to continue coverage. This strict framework aims to manage costs but also limits the number of beneficiaries who can access these medications.
Meanwhile, North Carolina’s State Health Plan chose to discontinue GLP-1 coverage for state employees, citing projected costs of $1 billion over six years. This contrast between Medicaid programs within states highlights the complexity of balancing medical innovation with budgetary constraints.
Federal Policies and Pricing Challenges Shape Access to Glp-1 Treatments
At the federal level, Medicare does not currently cover GLP-1 drugs for obesity, although they are approved for diabetes and other conditions.
The Trump administration declined to finalise a rule proposed under the Biden administration that would have expanded access to an estimated 7.4 million Medicare and Medicaid beneficiaries for weight loss treatment, according to health policy experts.
Pricing remains a major obstacle. The manufacturer Novo Nordisk recently lowered the cash price of Wegovy from $650 to $499 per month, but insurance plans and patients often face higher costs. Many individuals require long-term treatment to maintain weight loss, compounding financial burdens.
Health and Human Services Secretary Robert F. Kennedy Jr. has indicated openness to future coverage expansion if costs decrease, calling GLP-1s “extraordinary drugs.” However, widespread access is contingent on both federal policy shifts and reductions in pricing.
Public health officials praise state Medicaid expansions as steps forward but acknowledge the broader challenges in addressing obesity at the population level. Current strategies focus on lifestyle interventions and community health initiatives, with GLP-1 drugs representing one component of a multifaceted approach.
