Lawmakers Grapple With GLP-1 Access and Affordability

Lawmakers Grapple With GLP-1 Access and Affordability

About 1 in 8 U.S. adults are currently taking the diabetes and obesity drugs, which cost about $1,000 a month.

Glucagon-like peptide-1 receptor agonists, known as GLP-1s, are a class of prescription drugs used to help people with Type 2 diabetes manage their blood sugar levels and reduce their chances of stroke and heart attack, according to a study from Frontiers in Clinical Diabetes and Healthcare. The drugs also effect weight loss, leading to their use in the treatment of obesity.

Some studies indicate GLP-1s may reduce the risk of substance use disorders (Nature Medicine), neurocognitive disorders (including Alzheimer's disease), infectious diseases, some respiratory conditions and certain cancers (JAMA Oncology). Other research suggests the drugs might increase the risk of acute kidney injury (StatPearls) and gastrointestinal disorders (Nature Medicine).

Costs and Coverage

The average monthly price of GLP-1s ranges from $936-$1,023, and most large employer health plans restrict coverage of the drugs when prescribed primarily for weight loss, according to Health System Tracker, a partnership between KFF and the Peterson Center on Healthcare. Some analyses show that, at current prices, GLP-1s may not be as cost effective as certain surgical alternatives. For example, bariatric surgery could be a lower-cost and longer-lasting treatment for obesity, according to a study in JAMA Surgery.

Over 12% of adults say they are currently taking a GLP-1 drug, according to a recent KFF poll; nearly half report using them to manage at least one chronic condition such as diabetes or heart disease. About half report that their medicine was hard to afford, and while most insured adults say their plan covers at least some of the cost, 53% say the cost-sharing amount is still too high.

Related: NCSL's Prescription Drug Policy Resource Center

States offer prescription drug benefits through both state employee health plans and Medicaid, but coverage for GLP-1 medications varies. According to Leverage, a research platform funded by the Robert Wood Johnson Foundation, at least 15 states included anti-obesity drugs in their employee health plans in 2025, while nearly half the states limited coverage of GLP-1s.

State Medicaid agencies generally provide coverage for GLP-1s when they are prescribed to treat conditions such as diabetes. Whether those agencies cover the medications when they're used for obesity treatment varies. In addition, both public and private insurance providers use various cost-containment measures-such as requiring prior authorization-that can be adjusted over time.

Medicaid prescriptions for GLP-1s increased from about 1 million in 2019 to over 8 million in 2024, according to KFF. During that time, gross spending for the drugs rose from $1 billion to almost $9 billion. As of January, 13 state Medicaid programs cover GLP-1s for obesity treatment.

Federal law prohibits Medicare coverage of drugs used solely for weight loss. However, using a five-year federal model, the Centers for Medicare & Medicaid Services will negotiate pricing and coverage terms on GLP-1s for Medicare Part D plans and participating state Medicaid agencies beginning in 2027.

Legislative Action

Lawmakers routinely grapple with prescription drug affordability and access, and GLP-1s are complicating their efforts. State legislation applies only to state-regulated health insurance plans, such as state employee plans or those sold on the Affordable Care Act's individual and small-group marketplaces.

Since 2022, NCSL has tracked 66 bills in 25 states addressing GLP-1s for obesity treatment, with at least six states expanding access and others restricting it.

• Beginning in 2027, Colorado insurers must offer optional coverage for FDA-approved anti-obesity medications, including at least one GLP-1 medication.
• Connecticut passed legislation requiring action to petition the U.S. Department of Health and Human Services to authorize generic, lower-cost forms of FDA-approved GLP-1 drugs. Once approved, the state may contract with manufacturers and explore partnerships with other states.
• Florida passed legislation annually from 2022-2025 implementing a pilot program through the state employee health plan, which offers GLP-1 coverage and tracks participants' clinical health outcomes.
• Enrollees in the Illinois state employee health plan have GLP-1 coverage for weight loss and obesity.
• In contrast, changes to Michigan's Medicaid pharmacy rules mean GLP-1 drugs are approved only for people diagnosed with morbid obesity who have tried all other appropriate weight-loss treatment options without success.
• Washington is spending $250,000 to study a prescription drug benefit that includes FDA-approved weight-loss medications. Coverage of GLP-1s is limited until the legislature provides funding.

Looking Ahead

Recent state efforts illustrate how lawmakers are exploring a variety of strategies to manage demand for GLP-1 drugs while protecting state budgets and consumers' pocketbooks. As more data emerges from pilots, federal models and early-adopter states, policymakers will have many opportunities to refine coverage rules and develop more targeted approaches.

Colleen Berg is a project manager in NCSL's Health Program.