Colorado moves to limit GLP-1 coverage for state employees

Colorado's state employee health plan will limit coverage of GLP-1 medications to Type 2 diabetes, cardiovascular disease and obstructive sleep apnea starting July 1, 2025, according to the Colorado Department of Personnel & Administration.^[1] Employees who take the drugs only for weight loss will have to pay out of pocket, at a cost the state says runs more than $1,000 a month.^[1]

The change follows a rapid rise in spending. The state's GLP-1 benefit cost $1.5 million from July through December 2023, then $4 million in the following six months, then $7 million from July through December 2024, according to DPA.^[1] Spokesman Doug Platt said prescription costs have "doubled every six months."^[1] Colorado WINS, the state employees union, told reporters that 3,422 state employees were on Wegovy last year, about 2,000 were on Ozempic, and roughly 1,100 were on Zepbound, Eli Lilly's tirzepatide injection.^[1] DPA said 854 employees had a GLP-1 prescription solely for obesity as of July 2024, at an average state cost of just under $1,300 per prescription.^[1]

The policy shift comes as Colorado lawmakers try to trim nearly $1 billion from next year's budget because of rising Medicaid costs, the end of pandemic-era federal aid, and slower growth under the state's revenue cap.^[1] State Sen. Dafna Michaelson Jenet, a Commerce City Democrat who takes a GLP-1 for a prediabetes diagnosis and has lost 50 pounds on the drug, said she has asked the governor's office not to make the change and warned it could push some employees back toward diabetes.^[1] She has introduced a bill, facing what she calls long odds, that would require insurers and Medicaid to cover the drugs.^[1] A similar 2024 bill failed after legislative analysts estimated it would cost the state $86 million in its first year and at least $200 million a year after that.^[1]

Colorado is not alone in pulling back. West Virginia's state employee plan paused a pilot GLP-1 program in 2024 after costs reached $1.3 million a month, and North Carolina's state health plan ended weight-loss coverage in 2024 after utilization jumped 731% and projected costs topped $170 million in a year, on track to exceed $1 billion over six years.^[2] Illinois, by contrast, began covering the drugs for state workers in mid-2024 at an estimated first-year cost of $210 million.^[1][2] As of March 2025, only 11 states covered GLP-1s for weight loss under state employee plans, nine covered them under Medicaid, and five covered both.^[2]

Why it matters for patients

For the roughly 854 Colorado state employees using a GLP-1 solely for obesity, the July 1 change means losing insurance coverage unless they also have diabetes, heart disease or sleep apnea.^[1] Michaelson Jenet said her own copay of $30 a month would jump to about $1,400 a month without coverage.^[1] Because GLP-1 drugs' effects on appetite and weight often reverse once people stop taking them, losing coverage could mean losing the health improvements the drugs provided, according to reporting on how these medications work.^[1] The situation illustrates a broader pattern: several states that once covered these drugs for weight loss, including West Virginia and North Carolina, have scaled back because of cost, while others, like Illinois, have continued coverage despite high price tags.^[1][2]

What happens next

DPA says a final decision will be made through the legislature's budget process, and Colorado WINS said the Polis administration has agreed to discuss the plan further.^[1] Michaelson Jenet's 2025 bill requiring broader GLP-1 coverage faces a difficult path given the state's budget constraints, though she said she expects more lawmakers to hear from constituents once the July 1 change takes effect.^[1]