Medicaid GLP-1 coverage by state, from the prescriptions states paid
Pick a state and a drug: the tool shows how many prescriptions that state’s Medicaid program paid for, quarter by quarter, from CMS’s State Drug Utilization Data.
Federal law lets each state decide whether its Medicaid program pays for drugs used for weight loss, while coverage of GLP-1s for diabetes is required. Lists of which states cover obesity drugs go out of date quickly, so this page reads the record states leave behind: the State Drug Utilization Data that CMS publishes from the prescriptions each Medicaid program reimburses, by drug and by quarter. In the first quarter of 2026, the latest quarter most states have reported, Medicaid programs paid for 236,826 Wegovy and 365,721 Zepbound prescriptions nationwide, against 441,885 and 241,065 a year earlier. California paid for the most Wegovy prescriptions. A large drop shows when a state stops paying for obesity treatment: in Puerto Rico, Zepbound prescriptions fell from 1,957 to 0 over the year. A count above zero proves the state pays for the drug in some cases, not that it pays for weight loss.
California, every GLP-1 in Q1 2026
- Wegovy64,112
- Zepbound62,420
- Ozempic205,731
- Mounjaro117,016
- Trulicity25,265
- Rybelsus19,699
Prescriptions reimbursed, fee-for-service and managed care combined. Diabetes drugs (Ozempic, Mounjaro, Trulicity, Rybelsus) must be covered; Wegovy and Zepbound for weight loss are a state choice.
Wegovy prescriptions paid by California Medicaid, Q1 2026
64,112
$1,311 reimbursed per prescription
Prescriptions reimbursed, quarter by quarter
- Q1 2025214,640
- Q2 2025207,648
- Q3 2025308,846
- Q4 2025269,170
- Q1 202664,112
some rows hidden by CMS (under 11)
A count above zero shows the state pays for Wegovy in at least some cases; it does not say for which use. Nationwide, Medicaid programs reported 236,826 for the same quarter. Your copay is capped by federal rule ($4 for a preferred drug in the FY 2013 table, indexed since) and total cost sharing by 5% of family income. Estimate only: your state Medicaid agency decides coverage. Method
Prices read by Radif Partners · Editorial policy · Method and data
How to read the numbers
Each row of the CMS file is one drug package, in one state, in one quarter, split between fee-for-service Medicaid and managed care plans; we add both. Counts under eleven are hidden by CMS to protect privacy, which the tool flags. Wegovy and Zepbound have other covered uses, heart risk and sleep apnea, so a state that dropped obesity coverage still shows some prescriptions. The trend is the signal: a state that pays for weight-loss use shows thousands of prescriptions a quarter, and a policy change shows up as a break in the series.
The states with the most Wegovy and Zepbound prescriptions
| State | Wegovy, 2026 Q1 | Zepbound, 2026 Q1 | Wegovy, 2025 Q1 |
|---|---|---|---|
| California | 64,112 | 62,420 | 214,640 |
| North Carolina | 38,755 | 11,754 | 48,741 |
| Michigan | 31,965 | 44,662 | 47,209 |
| Tennessee | 19,383 | 19,193 | 2,836 |
| Minnesota | 19,166 | 7,043 | 19,622 |
| Wisconsin | 16,562 | 39,533 | 15,698 |
| Mississippi | 10,177 | 176 | 5,822 |
| Virginia | 4,468 | 3,531 | 7,113 |
| Massachusetts | 2,987 | 52,125 | 3,169 |
| Colorado | 2,850 | 4,429 | 1,042 |
| Ohio | 2,775 | 2,715 | 1,242 |
| Delaware | 2,738 | 2,547 | 4,502 |
Where coverage changed
Comparing the first quarter of 2026 with the same quarter a year earlier, the steepest falls in Zepbound prescriptions were in Puerto Rico (1,957 to 0), Pennsylvania (32,778 to 3,434), New Hampshire (1,177 to 318), California (93,284 to 62,420). For Wegovy they were in Pennsylvania (58,684 to 2,380), New Hampshire (2,973 to 307), California (214,640 to 64,112), South Carolina (1,368 to 485). Breaks of that size match decisions to end coverage for obesity; smaller moves can come from reporting delays. 0 states and territories reported no Wegovy prescription at all for the first quarter of 2026.
What you would pay
When Medicaid covers a drug, federal rule caps what the state may charge you (42 CFR 447.53). The latest table CMS publishes, for FY 2013, sets the maximum at $4 for a preferred drug at any income and, for a non-preferred drug, $8 up to 150% of the poverty level and 20 % of what the state pays above it. The rule raises the dollar maximums every October 1 since 2015 by the medical care consumer price index; that index rose 36.6 % from September 2013 to September 2025, the period covered through October 1, 2026, but CMS publishes no indexed amounts, and states may set their copays at or below the maximum. Your state plan, not the table, fixes your figure. Children, pregnant women and some other groups are exempt (447.56), and everything a household pays in premiums and cost sharing is capped at 5 % of family income, counted monthly or quarterly. From October 1, 2028, a new federal law requires cost sharing for expansion adults above the poverty level, up to $35 a service, but keeps prescription drugs at the nominal drug limits. The calculator’s Medicaid option asks only for your copay, $4 by default.
BALANCE: the federal model for Medicaid
CMS’s BALANCE Model lets state Medicaid agencies cover weight-loss GLP-1s at prices CMS negotiated with Eli Lilly and Novo Nordisk; states can join from May 2026 until January 1, 2027. CMS has not published a list of participating states. When one joins, its numbers in this tool should rise from the following quarters. People with both Medicare and Medicaid get Part D drug coverage through Medicare, where the $50 GLP-1 Bridge applies.