Most states reject the White House Medicaid deal offering Wegovy at $245 a month
POLITICO found 29 state Medicaid programs are turning down the federal GLP-1 pricing model that offers Wegovy at $245 a month, leaving coverage for weight loss shrinking in most states [1].
Most state Medicaid programs are rejecting the Trump administration's offer of discounted prices on GLP-1 obesity drugs, POLITICO reported on August 22, saying the cost is still too high for their budgets even at the negotiated rate [1]. Nine months after the president promised low-income Americans broad access to drugs like Wegovy (semaglutide) and Zepbound (tirzepatide), only Indiana has publicly signed on [1].
POLITICO surveyed state Medicaid agencies and found 29 said they will not participate in the payment model, with many citing costs and budget pressure [1]. Seven states — Arizona, Georgia, Michigan, Montana, Ohio, Tennessee and Virginia — are still deciding [1]. Fourteen states did not respond, and CMS declined to provide a list of participating states [1].
The price on the table
Novo Nordisk told POLITICO that states are offered a price of $245 per monthly dose of Wegovy under the model, and that the actual cost to states is likely lower once federal matching funds and manufacturer rebates are counted [1]. Indiana has said it will pay $85.16 of the $245 monthly cost per person [1].
Novo Nordisk argued the math should work out over time. "Wegovy in particular is a great option for patients because of the proven clinical benefit of reduced cardiovascular events and improved liver health," a company spokesperson said, adding that those conditions are "huge cost drivers" in Medicare and Medicaid [1]. Eli Lilly, which makes Zepbound, is also urging states to focus on the long-term picture [1].
States aren't convinced the savings arrive soon enough. Medicaid spending on GLP-1s grew from $1 billion in 2019 to almost $9 billion in 2024, and coverage for weight loss alone is optional under a decades-old federal law that excludes obesity drugs from mandatory Medicaid and Medicare coverage [1]. States must cover the drugs for conditions such as diabetes and heart disease [1]. Nearly 40 percent of patients with obesity might qualify if weight-loss coverage were added, and 70 million people rely on Medicaid [1].
California's Medicaid program stopped covering GLP-1s for weight loss at the start of this year after projecting costs would nearly quadruple to $800 million by 2028-29 [1]. Florida said joining the model would "require new, non-budgeted spending and legislative appropriation" [1]. New Mexico called it "not currently feasible," citing financial pressures created by the One Big Beautiful Bill Act [1]. In New Jersey and Kentucky, state law bars Medicaid from covering weight-loss drugs at all [1].
Why it matters for patients
For people on Medicaid, access to GLP-1s for obesity has narrowed, not widened. Twelve states currently cover the drugs for weight loss [1]. Over the past year, five states — California, Massachusetts, New Hampshire, Pennsylvania and South Carolina — ended coverage, and Rhode Island will end it in October [1]. POLITICO has previously reported that losing access can have severe effects on patients who lost significant weight on the medications [1].
Where Medicaid doesn't cover the drugs, enrollees can buy them out of pocket through TrumpRx at around $350 a month on average — still unaffordable for most low-income Americans, according to POLITICO [1].
The model also comes with strings. Participating states would have to adopt standardized coverage criteria, including a body mass index of 35 or higher; a person 5'10" would need to weigh 244 pounds to qualify [1]. CMS would have to approve any variations or stricter rules, and the model includes lifestyle support such as nutrition and fitness counseling [1]. Some states that already cover GLP-1s, including Minnesota and Missouri, are skipping the model — possibly because they believe their own negotiated net prices are better, said Johanna Butler of The National Academy for State Health Policy [1].
What happens next
Indiana plans to begin offering the drugs by the start of next year [1]. Michigan, which already covers GLP-1s for people with the most severe obesity classification, applied and was set to meet with CMS later in the month; if it and CMS agree, expanded coverage would take effect Jan. 1 [1]. Rhode Island's coverage ends in October [1].
Whether more states join later is not yet known. Butler expects most to take a "wait-and-see" approach, watching Indiana's Medicaid budget as federal cuts take effect: "States are wanting to see how the next year to three years plays out on the budget front" [1].
Sources
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