For the 40% of American adults with obesity, glucagon-like peptide-1 receptor agonists, or GLP-1 drugs, may offer hope—but the cost can put them out of reach for many patients.
GLP-1s are used primarily to treat people with Type 2 diabetes and, in some cases, obesity.
Those with obesity might have other serious chronic health conditions, including diabetes and high blood pressure, which are leading risk factors for heart disease and stroke. The data also shows that people living with obesity paid more annually in medical costs than their lighter counterparts ($3,097 versus $1,861 per person), totaling $173 billion in medical expenditures. In a study published in the Journal of Managed Care & Specialty Pharmacy, $260.6 billion in obesity-related care raised the costs of prescription drugs and costs across almost every category of inpatient and outpatient care.
What Are GLP-1 Drugs?
GLP-1 drugs have captured the attention of providers, patients and nonpatients alike because of amplified media coverage and soaring demand. These injectable therapies are recommended by the American Diabetes Association to lower the chances of heart attack and stroke in patients with diabetes. The drugs are among several pharmacological options that providers have to treat endocrine diseases. They might play an integral role in obesity-related disease management in conjunction with long-standing options such as diet, lifestyle modification and bariatric surgery.
GLP-1 drugs are effective because they delay the stomach from emptying, creating a feeling of fullness, thereby having an increased effect on weight loss. The health effects of long-term use of these medications for weight loss are unknown and still in clinical trials.
According to a KFF poll, 62% of adults taking GLP-1 drugs reported using them to manage a chronic condition such as diabetes or heart disease, while about four in 10 said they were prescribed GLP-1s primarily to lose weight. Research suggests maintenance dosages may be needed to sustain weight loss results. One analysis determined that participants who stopped taking GLP1-drugs had regained about two-thirds of their previous weight loss after one year. As noted, scientists are still trying to understand the sustainability of weight loss results.
NCSL Resources on GLP-1 Drugs
Growth, Volume, Price
The average annual list price of GLP-1s is $12,000 and, according to a Peterson-KFF tracker, most large employer health plans restrict coverage for weight loss. In the previous KFF poll, about half of all adults who took a GLP-1 drug said it was hard for them to afford it. And while most insured adults said their plan covered at least some of the cost, more than half of this group (53%) said the cost of the drug was unaffordable. Even with cost as a consideration for some, a dramatic uptick in demand has produced recent shortages, creating barriers for others needing these medicines.
Gross Medicaid spending in 2022 for GLP-1 drugs was $4.1 billion, according to Milliman. Furthermore, KFF reports that the number of prescriptions increased by more than 400% between 2019 and 2023, and in 2023, spending per prescription before rebates reached more than $900.
2024 State Action
Late last year, Illinois adopted a bill to cover certain weight loss and obesity medicines, including GLP-1s, under the state employee health plan. Moving in the opposite direction earlier this year and citing cost constraints, the state health plan in North Carolina restricted coverage of GLP-1s to members with particular health conditions—and weight loss would no longer qualify. The state treasurer has issued a request for information seeking ways to lower the cost of GLP-1 drugs to treat obesity.
In KFF’s 2024 annual budget survey, 13 states under Medicaid fee-for-service contracts cover GLP-1s for obesity treatment, and most require prior authorization for prescription approval. Two-thirds of states said cost was a deciding factor in covering the drugs.
Both public and private payers use cost containment policies to control the amount and mix of drugs included under the prescription drug benefit, which may be administered by a pharmacy benefit manager, or PBM. States have the option of imposing either stricter or looser requirements on these polices.
About a dozen states addressed the coverage of GLP-1 drugs during 2024 sessions, but the patchwork of policy pursuits largely failed. It is important to note that 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.
A recently proposed federal rule may require Medicaid and Medicare to cover GLP-1s when used to treat obesity. (Find more information here.)
What’s Ahead in 2025?
Obesity is a common, costly disease that, as the CDC reports, affects some groups more than others, including Black adults and adults with less education. New innovations for obesity are quickly coming to market, and the list of indications GLP-1 drugs could treat is expanding.
As experts continue to study the impact that GLP-1s have on health outcomes, state budgets, people’s lives and out-of-pocket costs, it is expected that the drugs will remain a topic of conversation among state lawmakers, Medicaid agencies, stakeholder groups and many others during the coming 2025 legislative session.
Colleen Becker is a project manager in NCSL’s Health Program.