Overview
- Effective Jan. 1, California’s Medi‑Cal stopped covering GLP‑1 drugs prescribed solely for weight loss, while continuing coverage for diabetes and other approved indications.
- Pennsylvania ended Medicaid payment for GLP‑1s used only for adult weight management, with coverage maintained for conditions like diabetes as state officials cite rising program costs.
- The FDA last month approved the first GLP‑1 pill for weight loss, marketed as the Wegovy pill, with cash prices of $149 for starter doses and $299 for higher doses expected as it becomes available this month.
- Cash‑pay access is widening through manufacturer programs and retailers, with injections offered around $499 a month at Costco and Walmart, and the TrumpRx.gov portal launching this month to link patients to discounts that the White House says will start injections near $350 a month.
- Insurers are narrowing coverage for obesity treatments, leaving roughly three‑quarters of Medicaid enrollees without GLP‑1 weight‑loss coverage, while CMS’s proposed BALANCE Model is slated to start in May 2026 for Medicaid and Jan. 2027 for Medicare Part D on a voluntary basis.