Between 2022 and 2024, roughly 25 states applied some type of taxpayer-funded protection for anti-obesity drugs. As reported on Pharmacy Instances, through the first 2 quarters of 2025, a minimum of 14 states launched laws or took regulatory actions impacting protection for glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) medication. State actions have been directed to particular person or group well being plans, state Medicaid applications, or each.
In January 2025, North Dakota turned the primary state to mandate insurance coverage protection for GLP-1 and GIP drugs by amending the state Important Well being Profit (EHB) clause. This was achieved by way of the Reasonably priced Care Act (ACA), a North Dakota statute enacted in 2023, and an up to date regulation from the state insurance coverage division, which collectively added the medication to the EHB plan for the state.2 Which means particular person and group well being plans should present protection for these drugs to be compliant with the provisions of the ACA.
State initiatives directed towards mandating protection by particular person and group well being plans embrace the next:
• California: AB 575 directs plans to cowl outpatient prescriptions for a minimum of 1 antiobesity treatment.
• Colorado enacted a legislation (SB 25-048) that enables people to buy prolonged protection for GLP-1 medication. This can be a pull-back from a earlier program that lined these medication for state workers.
• Connecticut: HB 5038 directs protection of GLP-1 medication for state workers, and HB 5485 directs protection of GLP-1 medication for different qualifying people.
• Iowa: SSB 1138 would require state well being companies to evaluation anti-obesity/GLP-1 medication as a prescription profit for state workers.
• Montana: SB 417 would have mandated protection for anti-obesity drugs. This invoice didn’t advance to enactment.
• New Mexico: SB 193 would have mandated protection for anti-obesity drugs. This invoice didn’t advance to enactment.
• Texas: HB 2412 would have mandated protection for GLP-1 drugs. This invoice didn’t advance to enactment.
• Washington: HB 1197/SB 5166 would require state company reviews on future insurance coverage protection for GLP-1 medication within the state medical plan.
• West Virginia: HB 2912 would require insurance coverage protection of GLP-1 medication for a affected person with a sound prescription.
State initiatives directed towards extending protection inside Medicaid applications embrace the next:
• Arkansas: HB 1332 would have required the state’s Medicaid to judge claims for the analysis frequency of obesity-related situations and the price of the situations. This invoice didn’t advance from the Senate.
• Mississippi: SB 2867 would have added protection of GLP-1 drugs to state Medicaid plans. This invoice handed the legislature however was vetoed by the governor on the grounds of fiscal challenges to the state. The invoice included protection for a lot of different well being care reimbursement issues and was not restricted to GLP-1 drugs.
• Virginia lawmakers launched an modification to the state’s Medicaid plan. Virginia at the moment covers GLP-1 drugs for the therapy of weight problems; nonetheless, this reimbursement relies on a number of elements, together with documented proof of medical necessity, prior authorization necessities, affected person eligibility and budgetary constraints inside the state’s Medicaid program.
The economics of GLP-1 brokers and different pharmacologic therapies for weight problems stay central to coverage choices on insurance coverage protection. The medical proof of a optimistic profit from these brokers continues to build up. Maybe this proof will ultimately tip the scales in favor of protection and open entry to extra sufferers.
