Several US states and cities have begun restricting or ending Medicaid coverage of GLP-1 weight-loss drugs such as Ozempic and Wegovy, as demand surges and public spending on the medications skyrockets. The pullback, driven by a 500% increase in national expenditure on these drugs between 2018 and 2023, affects low-income residents and public employees who previously relied on state-funded access.
According to a report in the Journal of the American Medical Association, US spending on GLP-1 drugs rose from $13.7bn in 2018 to $71.7bn in 2023. While the country’s adult obesity rate fell from 40% in 2023 to 37% in 2025, the financial burden has prompted tough choices. As of January 2026, California, New Hampshire, Pennsylvania, and South Carolina have ended Medicaid coverage for weight loss, and Michigan now restricts it to those classified as morbidly obese (BMI over 40). Rhode Island’s governor has also proposed ending coverage.
Pennsylvania exemplifies the dilemma: its Medicaid spending on GLP-1 drugs reached $1.3bn in 2025, double the previous year. The state now only covers the drugs for diabetes or a narrow set of criteria, such as sleep apnea combined with a BMI of at least 35. State Representative Arvind Venkat, a physician, argued that this approach “essentially allows 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.”
Healthcare experts warn that dropping coverage may provide short-term fiscal relief but will likely lead to higher long-term costs from obesity-related illnesses. Dr Matthew Klebanoff, assistant professor at the Perelman School of Medicine, noted that “patients should have access to these therapies” but acknowledged the challenge for payers. New York City stopped covering GLP-1 drugs for city employees in 2025, and Boston is considering similar limits due to an insurance rate hike largely driven by these drugs.
The impact on patients is stark. Alexa Canciello, a 23-year-old Medicaid recipient with autism, lost nearly 30 pounds on Zepbound before Pennsylvania ended her coverage in January. Without insurance, monthly injections cost over $400; her doctor has now prescribed a cheaper pill form of Wegovy. Her father Rich called the drugs “miracle workers,” highlighting the difficult trade-offs states face as they balance budgets against public health needs.
