Overview
- Pennsylvania ended Medicaid coverage for GLP-1 drugs prescribed solely for adult weight management effective Jan. 1, 2026, while keeping coverage for diabetes and certain other conditions.
- California’s Medi-Cal will no longer cover GLP-1s when prescribed strictly for weight loss starting Jan. 1, 2026, affecting brands including Wegovy, Ozempic, Mounjaro and Zepbound.
- The FDA cleared Novo Nordisk’s Wegovy pill last month, with U.S. rollout beginning this month and manufacturer-stated cash prices of $149 for starting doses and $299 for higher doses, with some insured copays potentially as low as $25.
- The Trump administration is launching TrumpRx.gov this month to connect patients to drugmakers’ discount sites, with average monthly injection costs expected to start near $350 and decline toward $250 over two years.
- Insurers and some employers are scaling back obesity-drug coverage as direct-to-consumer options grow, and federal proposals like the BALANCE Model to expand access in Medicaid and Medicare are slated to begin in 2026–2027 with voluntary participation.