Most state Medicaid programs decline White House deal offering Wegovy at $245 a month
Medicaid patients in most states will keep facing no weight-loss coverage or out-of-pocket prices averaging about $350 a month, as states cite budget strain.
Twenty-nine state Medicaid programs have told POLITICO they will not join the Trump administration's model for buying weight-loss drugs at a discount, leaving Indiana as the only state that has publicly enrolled [1]. The program offers Novo Nordisk's Wegovy to states at $245 per monthly dose [1].
Seven states — Arizona, Georgia, Michigan, Montana, Ohio, Tennessee and Virginia — described themselves as undecided, while 14 others did not answer POLITICO's questions [1]. CMS would not release a roster of participants; a spokesperson said details on the model's future "will be shared as it becomes available" [1].
Novo Nordisk says the $245 figure overstates what states actually pay once federal matching funds and manufacturer rebates are applied [1]. Indiana has put its own share at $85.16 per person per month and expects to start covering the drugs by the beginning of next year [1]. Maine, New Mexico and Oklahoma were among the states that declined, pointing to budget limits and doubts about whether the model's economics hold up over time [1].
The hesitation follows years of steep growth in Medicaid's GLP-1 bill: spending rose from $1 billion in 2019 to nearly $9 billion in 2024 [1]. Twelve states currently pay for the drugs for weight loss; five — California, Massachusetts, New Hampshire, Pennsylvania and South Carolina — have dropped that coverage in the past year, and Rhode Island plans to stop in October [1]. California's program ended weight-loss coverage in January after projecting its costs would almost quadruple to $800 million by 2028-29 [1].
Florida concluded that participating would "require new, non-budgeted spending and legislative appropriation," and Oregon said it would need "significant additional investment" from lawmakers [1]. New Jersey and Kentucky have laws barring Medicaid payment for weight-loss drugs [1].
Enrollment rules under the model are tight: patients would need a body-mass index of 35 or above — 244 pounds for someone 5 feet 10 inches tall — with CMS approval needed for any variations or stricter limits, and the model also funds nutrition and fitness counseling [1].
Novo Nordisk's spokesperson called Wegovy "a great option for patients because of the proven clinical benefit of reduced cardiovascular events and improved liver health," saying lower rates of those events would cut program costs [1]. Eli Lilly, which makes Zepbound, is urging states to weigh the long-term picture against the immediate budget hit, a company spokesperson said [1]. Johanna Butler of the National Academy for State Health Policy said the timing and size of any savings are hard to predict, which complicates the case for coverage [1].
Why it matters for patients
Medicaid must cover GLP-1s for diabetes and heart disease, but weight loss alone is optional [1]. That leaves roughly 70 million Medicaid enrollees in a system where nearly 40 percent of people with obesity might be candidates for treatment if states chose to pay for it [1].
Where states do not cover the drugs, enrollees can buy them out of pocket through the TrumpRx discount platform, where prices average about $350 a month — beyond reach for many low-income patients [1]. President Donald Trump said in November that monthly costs above $1,000 were ending, telling an Oval Office audience, "That ends starting today" [1].
Losing coverage can be disruptive. POLITICO reported that some Medicaid patients lost hundreds of pounds on the medications and saw major health improvements before their access changed [1]. Louisiana Medicaid Director Seth Gold said his state wants to be certain it can sustain coverage before starting it, saying the federal model "just was not something that we could readily be able to make work" [1].
What happens next
Michigan, which already covers GLP-1s, has applied and meets with CMS this month; if approved, it would extend coverage on Jan. 1 to people with moderate to severe obesity and conditions such as high blood pressure or Type 2 diabetes, widening its current rule that requires the most severe obesity classification [1]. Virginia and Tennessee, both current coverers, are still evaluating [1].
Butler said most states will watch Indiana's experience over the next one to three years before changing course [1]. Gold said he expects manufacturers, now more eager for Medicaid coverage, to keep bargaining directly with states [1].
Sources
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