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GLP-1 Boom Hits a Crossroads as States Cut Coverage and Next‑Gen Drugs Advance

Budget pressures alongside mixed late-stage data are reshaping access and expectations.

Overview

  • Use has gone mainstream, with 1 in 8 U.S. adults reporting they currently take a GLP-1 for weight loss or a chronic condition, according to KFF.
  • Several Medicaid programs are reversing or narrowing obesity coverage, including North Carolina’s recent halt and planned January 1 ends in California, New Hampshire and South Carolina, with Michigan moving to tighter eligibility.
  • Price-cut agreements with the White House and plans by Eli Lilly and Novo Nordisk to sell directly to employers signal broader access efforts as Lilly’s valuation briefly hit $1 trillion.
  • Late-stage pipelines highlight oral options and multi-hormone drugs: Novo Nordisk’s oral semaglutide showed about 13.6% weight loss and Eli Lilly’s orforglipron posted favorable results, while agents like retatrutide and amylin-based combinations target greater efficacy and convenience with potential 2026 rollouts.
  • New evidence underscores open questions on safety and durability, including an Alzheimer’s trial failure for oral semaglutide, substantial weight regain after stopping tirzepatide, and uncertain risks around pregnancy and postpartum use.