Medicaid GLP‑1 use was higher in states covering obesity treatment, but stayed below 5%

What happened

A state-level study found that obesity-indicated GLP-1 use among Medicaid beneficiaries without diabetes was higher in states that covered the medicines for obesity. Even in states with coverage, estimated use remained low.

The researchers analyzed Medicaid claims from 2016 through 2023 for beneficiaries ages 18 to 64 without diabetes. They counted claims for three GLP-1 medicines approved for obesity and used survey data to estimate each state's Medicaid population with obesity but without diabetes. Eleven states had Medicaid obesity-drug coverage in 2023.

Prescription volume in the study population rose from fewer than 10,000 prescriptions per year through 2020 to about 369,000 in 2023. In that year, median estimated use was 1.4% in states with obesity coverage and 0.001% in states without it. The difference met the study's statistical threshold. Estimated use was below 5% in every state.

The result remained similar when the authors accounted for uncertainty in the survey estimates and when they excluded Kansas and Mississippi, where coverage began partway through 2023.

What it means

Formal coverage appears to be an important condition for access. States without an obesity benefit recorded almost no use in this analysis. Coverage did not produce broad access by itself, however. The low rates in covered states point to other possible barriers, including prior authorization, benefit design, medication availability, prescriber access, and the cost pressures facing state programs.

The study is also useful because it excluded people with diabetes. That made the claims more specific to obesity treatment instead of mixing obesity use with GLP-1 prescriptions written for diabetes.

What it does not mean

This ecological comparison cannot prove that adopting coverage caused the higher use. States differ in many ways beyond whether their policy was classified as covered or not covered.

The denominator was estimated rather than measured from individual BMI values. The researchers combined Medicaid claims with state survey estimates because BMI was unavailable in the claims. They also could not fully account for differences between the survey population and the claims population, restrictions within covered benefits, medication shortages, off-label use, or other approved indications.

A filled claim does not show whether a person stayed on treatment or benefited from it. The findings describe access and use at the state level, not the right treatment choice for an individual.