09/02/2026
Latest from the Public Sector Healthcare Roundtable: Most States Decline Federal Medicaid GLP-1 Pricing Model
Nine months after the Trump administration introduced a payment model allowing states to access discounted pricing on GLP-1 weight-loss medications through Medicaid, only one state, Indiana, has committed to participate. 29 state Medicaid programs have declined to participate. States who have declined participation cited cost concerns, budget constraints, and doubts regarding the model's long-term financial sustainability. Some of these states opted out of the federal program because they prefer to negotiate coverage and pricing directly with drugmakers.
Budgetary pressures have already prompted a number of states to scale back or discontinue GLP-1 coverage. Medicaid expenditures on GLP-1 medications rose substantially, from approximately $1 billion in 2019 to nearly $9 billion in 2024, a trend that may continue given the significant proportion of Medicaid enrollees with obesity who could be eligible for treatment if states expand their coverage of the medication to include weight loss indications. Seven states, Arizona, Georgia, Michigan, Montana, Ohio, Tennessee, and Virginia, indicated they are still deciding whether to participate.
Blue and red states say accepting federal help to expand access to drugs like Wegovy for America's poorest patients is too much of a drain on their budgets.