States Push Forward on Insurance Mandates for GLP-1 and Obesity Treatments

Between 2022 and 2024, approximately 25 states implemented some form of taxpayer-funded coverage for antiobesity medications.¹ During the first 2 quarters of 2025, at least 14 states introduced legislation or took regulatory actions impacting coverage for glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) drugs. State actions have been directed to individual or group health plans, state Medicaid programs, or both.^1,2

In January 2025, North Dakota became the first state to mandate insurance coverage for GLP-1 and GIP medications by amending the state Essential Health Benefit (EHB) clause. This was accomplished through the Affordable Care Act (ACA), a North Dakota statute enacted in 2023, and an updated regulation from the state insurance department, which collectively added the drugs to the EHB plan for the state.² This means that individual and group health plans must provide coverage for these medications to be compliant with the provisions of the ACA.²

State initiatives directed toward mandating coverage by individual and group health plans include the following²:

• California AB 575 directs plans to cover outpatient prescriptions for at least 1 antiobesity medication.

• Colorado enacted a law (SB 25-048) that allows individuals to purchase extended coverage for GLP-1 drugs. This is a pull-back from a previous program that covered these drugs for state employees.

• Connecticut HB 5038 directs coverage of GLP-1 drugs for state employees, and HB 5485 directs coverage of GLP-1 drugs for other qualifying individuals.

• Iowa SSB 1138 would require state health agencies to review anti-obesity/GLP-1 drugs as a prescription benefit for state employees.

• Montana SB 417 would have mandated coverage for antiobesity medications. This bill did not advance to enactment.

• New Mexico SB 193 would have mandated coverage for antiobesity medications. This bill did not advance to enactment.

• Texas HB 2412 would have mandated coverage for GLP-1 medications. This bill did not advance to enactment.

• Washington HB 1197/SB 5166 would require state agency reports on future insurance coverage for GLP-1 drugs in the state medical plan.

• West Virginia HB 2912 would require insurance coverage of GLP-1 drugs for a patient with a valid prescription.

State initiatives directed toward extending coverage within Medicaid programs include the following¹:

• Arkansas HB 1332 would have required the state’s Medicaid to evaluate claims for the diagnosis frequency of obesity-related conditions and the cost of the conditions. This bill did not advance from the Senate.

• Mississippi SB 2867 would have added coverage of GLP-1 medications to state Medicaid plans. This bill passed the legislature but was vetoed by the governor on the grounds of fiscal challenges to the state. The bill included coverage for many other health care reimbursement matters and was not limited to GLP-1 medications.

• Virginia lawmakers introduced an amendment to the state’s Medicaid plan. Virginia currently covers GLP-1 medications for the treatment of obesity; however, this reimbursement is predicated on several factors, including documented evidence of medical necessity, prior authorization requirements, patient eligibility, and budgetary constraints within the state’s Medicaid program.

The economics of GLP-1 agents and other pharmacologic therapies for obesity remain central to policy decisions on insurance coverage. The clinical evidence of a positive benefit from these agents continues to accumulate. Perhaps this evidence will eventually tip the scales in favor of coverage and open access to more patients.

REFERENCES

1. Ingmire B. GLP-1 weight loss drugs: coverage under Medicaid and other health plans. Multistate. March 17, 2025. Accessed September 3, 2025. https://www.multistate.us/insider/2025/3/17/glp-1-weight-loss-drugs-coverage-under-medicaid-and-other-health-plans

2. States consider requiring insurers to cover weight-loss drugs. LexisNexis. March 19, 2025. Accessed September 3, 2025. https://www.lexisnexis.com/community/insights/legal/capitol-journal/b/state-net/posts/states-consider-requiring-insurers-to-cover-weight-loss-drugs