Glucagon-Like Peptide-1 Receptor Agonists and Medicaid: Insights From Policy and Prescription Data

State Medicaid programs vary in whether they cover glucagon-like peptide-1 receptor agonists (GLP-1s) for obesity treatment, creating an opportunity to examine how utilization differs across coverage environments. We combined 2024 KFF Medicaid coverage data with Medicaid State Drug Utilization Data from 2015 to 2024 across all 50 states and Washington, D.C. As of August 2024, 13 states covered GLP-1s for obesity, and prescriptions were concentrated in those states, reaching 16.2 per 1,000 Medicaid beneficiaries in Q4 2024. Prescription rates for obesity-indicated GLP-1s were higher in states with coverage and showed no consistent patterns across states with different utilization management requirements. GLP-1 prescriptions were more common in managed care than fee-for-service plans. GLP-1 prescribing varies substantially across state Medicaid coverage environments, underscoring the importance of monitoring how utilization evolves as state coverage policies change.