North Carolina Medicaid restores GLP-1 obesity coverage after October cut
North Carolina resumed paying for GLP-1 obesity drugs in December 2025, but Medicaid coverage of these medications still depends on which state a patient lives in and what diagnosis is on the prescription.
North Carolina Medicaid resumed covering GLP-1 medications prescribed for obesity on Dec. 12, 2025, restoring a benefit it had cut about 10 weeks earlier [2][3]. The reversal came under a directive from Gov. Josh Stein and returned the program to the coverage criteria in place before the October cutoff [3].
North Carolina ended obesity coverage effective Oct. 1, 2025, citing a shortage of state funding for the Medicaid program; coverage continued when the drugs were prescribed for other reasons, including diabetes and certain cardiovascular conditions [3]. The state health department announced the reinstated benefit in a notice dated Dec. 19, 2025 [1]. The restored benefit keeps Medicaid's clinical and prior-authorization requirements [3], and covers Wegovy and Zepbound for weight management while removing Saxenda from the state's list, according to a state-by-state tracker [2].
Nationally, KFF counted 13 state Medicaid programs covering GLP-1s for obesity under fee-for-service as of January 2026 [1]. KFF's 2025 Medicaid budget survey had found 16 states covering as of October 2025, but since then California, New Hampshire, Pennsylvania and South Carolina eliminated obesity coverage, and North Carolina's reinstatement brought the total to 13 [1].
What the North Carolina numbers show
In June, 34,524 North Carolina Medicaid beneficiaries had GLP-1 claims for weight loss, totaling $47,855,225 — about $1,386 per beneficiary for the month [3]. Those beneficiaries represent roughly 1.1% of the more than 3.1 million people covered by North Carolina Medicaid [3]. The department told Carolina Journal the figure is the amount before federal matching funds and manufacturer rebates are applied, and said the rebates are significant but their amounts are not publicly available [3].
The state's separate health plan for public employees took the opposite path. The State Health Plan board voted in January 2024 to end weight-loss coverage, when more than 23,000 members were using the drugs at a net cost of more than $800 per member per month after rebates, and officials projected spending would exceed $170 million in 2024 and $1 billion over six years [3]. A spokesperson for the State Treasurer's Office said current prices "remain unaffordable given the Plan's financial condition," and the plan still covers the drugs for members diagnosed with diabetes [3].
Why it matters for patients
Federal Medicaid law requires states to cover nearly all FDA-approved drugs, but weight-loss drugs are among a small group of categories states may exclude [1]. That is why coverage of GLP-1s for obesity is optional and varies by state, while coverage is required for diabetes and, since March 2024, for cardiovascular risk reduction with Wegovy, and since December 2024 for moderate-to-severe obstructive sleep apnea with Zepbound in adults with obesity [1][2]. A newer Wegovy indication for noncirrhotic MASH, a liver disease, is likewise required, according to the tracker [2].
The practical result is that the same molecule can be covered or denied depending on the diagnosis written on the prescription [2]. KFF notes that about four in ten adults with Medicaid have obesity, and that when a state does cover GLP-1s for obesity, the drugs are typically subject to prior authorization, which can further limit access [1]. Because enrollees pay little or no copay for prescriptions, KFF adds, people on Medicaid are unlikely to obtain the drugs without coverage even at lower prices [1].
The count has moved again since. The RX Index reported 11 states with verified Medicaid coverage for GLP-1 weight-loss drugs as of July 10, 2026, after Utah's legislative pilot ended June 30 and Massachusetts ended coverage July 1 [2]. Rhode Island covers the drugs for weight loss through Sept. 30, 2026, with its enacted budget restricting Medicaid coverage to type 2 diabetes starting Oct. 1, 2026 [2]. Michigan tightened its rules on Jan. 1, 2026, limiting coverage to beneficiaries with a BMI of 40 or higher who have documented failure of other options and are seeking to avoid bariatric surgery [2].
What happens next
North Carolina's April Medicaid funding law directs the state health department to build a cost-savings and efficiency plan, including giving managed care plans more flexibility to control weight-loss GLP-1 use and requiring participation in nutrition, weight-loss and lifestyle programs [3]. The plan is due to legislative oversight committees by Oct. 1, and implementation cannot begin before July 1, 2027 [3].
At the federal level, the Centers for Medicare & Medicaid Services introduced the five-year, voluntary BALANCE model in December 2025 to negotiate lower GLP-1 prices for Medicaid and Medicare, with standardized coverage criteria and lifestyle supports; states and manufacturers were asked to state their intentions to participate by Jan. 8, 2026, and the model is expected to begin in May 2026 [1]. For Medicare Part D, the model would take effect in January 2027, after a separate short-term demonstration allowing Part D enrollees to get obesity drugs starting in July 2026 [1]. In November 2025, the administration also announced a deal with Eli Lilly and Novo Nordisk to lower GLP-1 prices for Medicare, Medicaid and direct purchases through a new TrumpRx website [1]. How those prices compare with what state Medicaid programs pay now has not been disclosed [1].
Sources
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