Between 2022 and 2024, around 25 states implemented taxpayer-funded coverage for anti-obesity medications. According to Pharmacy Times, in the first half of 2025, at least 14 states introduced legislation or regulatory actions affecting coverage for glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) drugs. These actions targeted individual or group health plans, state Medicaid programs, or both.
In January 2025, North Dakota became the first state to require insurance coverage for GLP-1 and GIP medications by amending the state Essential Health Benefit (EHB) clause. This was achieved through the Affordable Care Act (ACA), a North Dakota statute passed in 2023, and an updated regulation from the state insurance department, collectively adding the drugs to the EHB plan for the state. This mandate means that individual and group health plans must offer coverage for these medications to comply with the ACA provisions.
State efforts to mandate coverage by individual and group health plans include:
- California: AB 575 requires plans to cover outpatient prescriptions for at least one anti-obesity medication.
- Colorado: SB 25-048 permits individuals to purchase extended coverage for GLP-1 drugs, a change from a previous program covering these drugs for state employees.
- Connecticut: HB 5038 mandates coverage of GLP-1 drugs for state employees, while HB 5485 mandates coverage for other qualifying individuals.
- Iowa: SSB 1138 proposes that state health agencies evaluate anti-obesity/GLP-1 drugs as a prescription benefit for state employees.
- Montana: SB 417 aimed to mandate coverage for anti-obesity medications but did not progress to enactment.
- New Mexico: SB 193 sought to mandate coverage for anti-obesity medications but did not advance to enactment.
- Texas: HB 2412 aimed to mandate coverage for GLP-1 medications but did not advance to enactment.
- Washington: HB 1197/SB 5166 would necessitate state agency reports on future insurance coverage for GLP-1 drugs in the state medical plan.
- West Virginia: HB 2912 would require insurance coverage of GLP-1 drugs for patients with valid prescriptions.
State initiatives to expand coverage within Medicaid programs include:
- Arkansas: HB 1332 would have mandated the state’s Medicaid program to assess claims for the frequency of obesity-related conditions and their costs, but the bill did not advance from the Senate.
- Mississippi: SB 2867 would have added coverage of GLP-1 medications to state Medicaid plans. The bill passed the legislature but was vetoed by the governor due to fiscal challenges. The bill encompassed various healthcare reimbursement matters beyond GLP-1 medications.
- Virginia: Lawmakers introduced an amendment to Virginia’s Medicaid plan, which currently covers GLP-1 medications for obesity treatment under specific conditions.
The economic aspects of GLP-1 agents and other pharmacologic therapies for obesity are crucial in policy decisions regarding insurance coverage. The accumulating clinical evidence of the benefits of these agents may eventually lead to increased coverage and broader access for patients.