Nine months after President Donald Trump announced a deal offering states discounted pricing on GLP-1 drugs for Medicaid patients, most states are declining to participate, according to an Aug. 22 Politico report.
Only Indiana has publicly signed on, while 29 state Medicaid programs have said they will not participate and 14 more did not respond to requests for comment, according to the report. CMS also declined to provide a list of participating states.
Trump announced the pricing deal in November alongside Eli Lilly and Novo Nordisk, extending most-favored-nation pricing on GLP-1s to Medicare and state Medicaid programs that opt in. Under the model, states would pay $245 a month for drugs including Wegovy and Zepbound, with federal matching funds and manufacturer rebates potentially lowering the effective cost. States that have opted out, including Maine, New Mexico and Oklahoma, cited budget constraints and the risk of cost overruns seen in other states, according to the report. California’s Medicaid program, for example, dropped GLP-1 coverage for weight loss at the start of the year after projecting costs would nearly quadruple to $800 million by fiscal 2028-29.
Florida, Oregon, Hawaii and Vermont told Politico the model would require new, unbudgeted spending, while New Jersey and Kentucky prohibit Medicaid coverage of weight-loss drugs. Michigan, which already covers GLP-1s through Medicaid, applied to participate in the state-level model and is meeting with CMS this month, while Virginia and Tennessee are still evaluating whether to participate, according to Politico.
CMS’ parallel push to expand GLP-1 access through Medicare is also still taking shape. The Medicare GLP-1 Bridge program, which launched July 1 and runs through the end of 2027, offers eligible Medicare Part D beneficiaries the same drugs at a $245 net price with a $50 copay. However, CMS has not disclosed enrollment or savings figures for the program.
Medicaid spending on GLP-1s grew from $1 billion in 2019 to almost $9 billion in 2024, and nearly 40% of patients with obesity could qualify for coverage if states opted in, according to the report. States that do not cover the drugs can still direct Medicaid enrollees to purchase them out of pocket through TrumpRx. The platform lists injectable Wegovy and Ozempic at average prices of about $350 a month, down from more than $1,000, though some pricing comparisons have found many listed drugs are available for less through existing Medicare Part D or Medicaid discounts. Even at the discounted rates, the drugs may remain unaffordable for many low-income patients.
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