Covering the High Cost of Weight Loss Drugs

Covering the High Cost of Weight Loss Drugs

GLP-1 products have been found to help in fighting obesity, but their steep prices pose problems for patients and state budgets alike.

Several states are exploring ways to manage the cost of and access to GLP-1 medications. Some now require state-regulated health plans to cover GLP-1s for obesity within existing budgets; others are waiting until new funding is appropriated. (Milko/Getty Images)

The sweeping popularity of GLP-1 medications for weight loss poses challenges for state and federal health care budgets and drug safety oversight.

Colleen Becker, a project manager with the NCSL Health Program, laid out both the medical promise and the political pressure surrounding GLP-1 weight loss drugs during a session at the NCSL Base Camp 2025 policy meeting. The drugs include well-known brand names such as Ozempic and Wegovy.

"Public and legislative interest is still growing," Becker says, noting that 1 in 8 adults reports taking a GLP-1, according to a KFF poll. But even as demand surges, steep price tags-often ranging from $900 to $1,300 a month-pose problems for patients and state budgets alike.

"There's no perfect answer here, but the price really has to come down."

-Stacey Dusetzina, health policy professor and prominent drug-pricing researcher, Vanderbilt University

Becker says weight loss with a GLP-1 medication averages between 3.6% and 8.7% in the first year, and research shows reduced cardiovascular and diabetes risk. GLP-1 spending has jumped more than 500% since 2018. Medicaid programs, required to cover FDA-approved drugs, are now grappling with how to absorb the cost of a therapy that many patients need long term, she says.

Several states are exploring ways to manage the cost and access. Some, including Colorado, now require state-regulated health plans to cover GLP-1s for obesity within existing budgets. Others, such as Washington, have delayed coverage until new funding is appropriated, while Connecticut lawmakers are examining whether the state could petition federal agencies to pave the way for generic versions or pursue multistate bulk purchasing agreements, she says.

Cost remains the central barrier. "There's no perfect answer here, but the price really has to come down," says Stacey Dusetzina, a Vanderbilt University health policy professor and prominent drug-pricing researcher. She adds that while insurers and employers want to offer the drugs to those with the highest clinical need-people with health issues in addition to obesity-they face a difficult reality: Manufacturers often refuse to provide all-important rebates if coverage is restricted that way.

The drugs typically require long-term use or patients will regain weight, Dusetzina says, so short-term cost controls may undermine long-term health gains. And many of the most significant savings, such as avoiding expensive cardiac events, accrue later in life. That means it often helps when patients are insured by Medicare rather than the employers or states footing the bill today.

Dusetzina says there's a growing list of conditions that the FDA has approved for treatment with GLP-1 medications, such as fatty liver disease and sleep apnea. That may allow more people to qualify for insurance coverage, which helps the patient but still raises costs for states.

She says the most promising way to control costs would be for states to join forces and negotiate prices.

"We're not necessarily seeing that yet, and it could just be that it's a little bit early where the manufacturers are trying to hold the line on how they think about giving concessions on the price," she says.

Josh Bolen of the National Association of Boards of Pharmacy says shortages and high demand have opened the door to counterfeit and unsafe compounded products, particularly in loosely regulated medical spas. In Ohio, where regulators have authority to "follow the drug" across settings, he says, inspectors found safety violations in more than half of the medical spas they visited. He says in 450 inspections, 56 % were required to take corrective action in how they manage the drug supply and administer the injections, and 6% had their license suspended or surrendered.

Most other states lack the statutory authority even to investigate, Bolen says.

"If states don't have the authority to go into these types of operations, that presents a real patient safety threat," he says.

NCSL is tracking the growing number of bills states are considering to manage GLP-1 medications as part of its Prescription Drug Legislation Database.

Kelley Giffin is a senior editor and the producer and host of NCSL's "Across the Aisle" podcast.