Between 2022 and 2024, roughly 25 states applied some type of taxpayer-funded protection for anti-obesity medicines. As reported on Pharmacy Instances, through the first 2 quarters of 2025, at the very least 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 packages, or each.
In January 2025, North Dakota turned the primary state to mandate insurance coverage protection for GLP-1 and GIP medicines by amending the state Important Well being Profit (EHB) clause. This was completed via 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 Because of this particular person and group well being plans should present protection for these medicines to be compliant with the provisions of the ACA.
State initiatives directed towards mandating protection by particular person and group well being plans embody the next:
• California: AB 575 directs plans to cowl outpatient prescriptions for at the very least 1 antiobesity medicine.
• Colorado enacted a regulation (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 coated these medication for state staff.
• Connecticut: HB 5038 directs protection of GLP-1 medication for state staff, and HB 5485 directs protection of GLP-1 medication for different qualifying people.
• Iowa: SSB 1138 would require state well being companies to overview anti-obesity/GLP-1 medication as a prescription profit for state staff.
• Montana: SB 417 would have mandated protection for anti-obesity medicines. This invoice didn’t advance to enactment.
• New Mexico: SB 193 would have mandated protection for anti-obesity medicines. This invoice didn’t advance to enactment.
• Texas: HB 2412 would have mandated protection for GLP-1 medicines. This invoice didn’t advance to enactment.
• Washington: HB 1197/SB 5166 would require state company stories 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 packages embody the next:
• Arkansas: HB 1332 would have required the state’s Medicaid to guage claims for the prognosis frequency of obesity-related circumstances and the price of the circumstances. This invoice didn’t advance from the Senate.
• Mississippi: SB 2867 would have added protection of GLP-1 medicines 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 medicines.
• Virginia lawmakers launched an modification to the state’s Medicaid plan. Virginia at the moment covers GLP-1 medicines for the therapy of weight problems; nonetheless, this reimbursement is based on a number of components, together with documented proof of medical necessity, prior authorization necessities, affected person eligibility and budgetary constraints throughout 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 scientific 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.
