Medicaid GLP-1 Spending by State (2019–2026)

Medicaid is one of the largest single payers for GLP-1 medications in the United States, and its spending is public — every state reports the prescriptions and dollars it pays for each drug, every quarter, to the Centers for Medicare & Medicaid Services.^[1] This tracker covers every GLP-1 medication in that State Drug Utilization Data, in every state, from 2019 through the first quarter of 2026. In 2024, US Medicaid spent $8.84B on GLP-1s in gross reimbursements — before the confidential rebates that make the net cost substantially lower — with Ozempic the single largest drug at $3.37B.

Two forces are reshaping that number. Spending on drugs labeled for weight loss is climbing fast: Zepbound's Medicaid spend grew 6.3× in a single year, and Wegovy's rose from $1.43B to $2.60B. At the same time, a wave of states moved to contain that cost — and the 2026 data already shows what happens when a state pulls coverage.

The headline numbers

The 2026 coverage cliff

A wave of state Medicaid programs ended GLP-1 coverage for obesity around the start of 2026, keeping the drugs available only for diabetes — by January 2026, just 13 state programs still covered them for obesity under fee-for-service. The prescription data shows the effect immediately. Pennsylvania, which terminated Wegovy, Zepbound, and Saxenda coverage for weight management on January 1, 2026, is the sharpest example: quarterly Wegovy prescriptions collapsed from 61,848 in the last quarter of 2025 to just 2,380 in the first quarter of 2026 — a 96.2% drop. California, which eliminated Medi-Cal obesity coverage in the same wave (later reinstating Wegovy only for the liver condition MASH), fell 76.2% (269,170 → 64,112) over the same window, and Michigan dropped 33.7% after new limits.

First-quarter 2026 figures are preliminary — states continue submitting utilization data for months after a quarter closes, so the declines above will soften somewhat as late reports arrive. But the direction is unambiguous: a state that stops paying for a drug for weight loss sees its prescriptions for that drug fall by most of their volume within one quarter. Whether coverage exists at all now depends heavily on where a patient lives — the same state-by-state divergence tracked in our state Medicaid GLP-1 coverage hub and the state Medicaid GLP-1 checker, which map each program's current obesity-coverage rules and prior-authorization pathway.

National spending trend, 2019–2025

Annual gross Medicaid reimbursement and prescriptions for the five highest-spend GLP-1s, from the CMS national series. Dollars are gross, before confidential rebates. The 2026 partial year is excluded here — only its first quarter has reported — and is shown separately in the state table and the coverage-cliff section above.

“All GLP-1s” sums every GLP-1 in the dataset, not just the five columns shown. A dash means the drug had no Medicaid volume that year (Wegovy launched in 2021, Zepbound in late 2023). Trulicity's decline reflects patients shifting to newer agents. Snapshot: July 2026.

The full state table

One row per state, plus DC and Puerto Rico. “2025 GLP-1 rx” and “2025 gross spend” sum every GLP-1 across both fee-for-service and managed care for calendar year 2025. “Anti-obesity share” is the portion of that gross spend going to drugs labeled for weight loss (Wegovy, Zepbound, Saxenda). “Q1 2026 Wegovy rx” is the first-quarter 2026 prescription count and is preliminary. Click a state name to open its Medicaid coverage and prior-authorization brief where one exists. Download the full table at the bottom of this page.

^† Puerto Rico's Medicaid program operates under a block-grant structure with different formulary rules and reports far lower GLP-1 volume than the states. All dollar figures are gross, before confidential rebates. Q1 2026 counts are preliminary and will rise as states file late reports. Snapshot: July 2026. The same rows are downloadable as CSV/JSON in the “Cite this data” section below.

Methodology

Every figure on this page comes from the Medicaid State Drug Utilization Data (SDUD), which CMS publishes on data.medicaid.gov.^[1][2] Each source row is a state × drug × quarter record; we sum across every national drug code and across both fee-for-service and managed-care utilization so each cell reflects total Medicaid volume. The national series uses CMS's own national rows, not a sum of the states.

All dollar amounts are gross reimbursements — before confidential federal and supplemental rebates. GLP-1 rebates are among the largest of any drug class, so the actual net cost to Medicaid is substantially lower than the gross figures shown here. These numbers are the right measure of gross program spending and relative trends across states and drugs; they are not the net budget impact, and no one should read them as such.

Suppression. CMS suppresses any cell with fewer than 11 prescriptions. We count those suppressed cells per aggregate rather than guessing at their value, which means totals that fold in suppressed cells are floors — the true figure is slightly higher. The most recent quarter is preliminary: states keep submitting utilization data for months after a quarter closes, so the latest quarter's counts (all of 2026Q1 here) will rise over subsequent releases.

Indication vs. what Medicaid paid for. The “class” label on each drug is its FDA-labeled indication, not necessarily the reason a given prescription was written. Ozempic is labeled for type 2 diabetes yet drives the largest single-drug spend, and some of that reflects off-label weight management; conversely, a diabetes patient may be prescribed Wegovy. SDUD does not carry a diagnosis, so “anti-obesity share” measures spend on drugs labeled for weight loss, which is a lower bound on GLP-1 spending tied to weight management.

Explore the data further

• State Medicaid GLP-1 coverage hub — the current obesity-coverage rules and prior-authorization pathway behind each state's spending.
• State Medicaid GLP-1 checker — look up whether your state's Medicaid program covers GLP-1s today.
• GLP-1 care access by state — NPI-verified clinic density and telehealth coverage in every state.
• GLP-1 Compounded Pricing Index — cash-pay monthly prices for patients who lose Medicaid coverage.