Poster #147 - Expanding Access to “Miracle Drugs”? The Impact of Medicaid Coverage on Take-Up of GLP-1 Medication

• In Event: Friday Poster Reception

Abstract

Obesity remains a significant public health concern in the United States, with recent data showing that 40.3% of adults aged 20 and over were classified as obese between August 2021 and August 2023. Obesity is associated with a range of serious health conditions, including Type-2 diabetes, cardiovascular diseases, and musculoskeletal disorders. Socioeconomic status plays a critical role in obesity prevalence. Individuals with lower incomes often face structural barriers, which contribute to disproportionately higher rates of obesity.

GLP-1 (Glucagon-Like Peptide-1) medications – such as Ozempic, Wegovy, and Mounjaro – have gained widespread popularity for their role in promoting weight loss and managing Type-2 diabetes. Yet, despite their potential, their high cost and limited insurance coverage of these medications remain significant barriers to access, particularly among low-income individuals. While the Food & Drug Administration (FDA) has approved specific GLP-1 medications for chronic weight management purposes, state Medicaid coverage of such medications remains optional. During 2023 and 2024, just 13 U.S. states extended Medicaid coverage to include these drugs for obesity treatment and chronic weight management, including one state that did not adopt the Affordable Care Act’s (ACA) Medicaid Expansion.

This research leverages the staggered adoption of Medicaid coverage for GLP-1 to examine whether the expansion of such coverage leads to an increase in GLP-1 medication take-up. While medical research establishes the efficacy of GLP-1 drugs in managing obesity and diabetes, much of the current literature focuses narrowly on clinical outcomes (e.g. Hendershot et al., 2025; Wang et al., 2024) rather than coverage-driven access disparities. In adjacent work, Hristeva et al., 2025 explore behavioral responses to GLP-1s such as changes in food consumption; however, to the best of our knowledge, examining the extent to which state-level Medicaid coverage affects utilization remains to be investigated. Our study contributes to a growing, yet scant, literature on GLP-1-related work.

We utilize publicly available quarterly data from the Centers for Medicare & Medicaid Services (CMS) Medicaid State Drug Utilization data from 2018 to 2024, to construct a panel dataset at the state-by-quarter level, and track changes in the volume and composition of Medicaid-reimbursed GLP-1 prescriptions over time. We adopt a simple Difference-in-Difference design, comparing states that expanded the Medicaid coverage for weight management to those that did not, while controlling for state and time fixed effects. We also explore heterogeneity in trends across specific GLP-1 drugs (e.g., Ozempic vs. Wegovy), as well as state Medicaid generosity.

Preliminary descriptive statistics indicate significant increases in GLP-1 take-up across the U.S., with some states showing sharp quarter-to-quarter jumps exceeding 50% in prescription volume. This research aims to provide preliminary evidence pertaining to the important role of state-level health policy in shaping access to medications important for tackling chronic health-related issues, especially those affecting diet-related disease. The results from this research will be utilized to shed light into the role of Medicaid in shaping access to weight management prescriptions – such as GLP1 drugs – for low-income populations across the U.S, with subsequent work including examining the impact of GLP-1 medication on various health-related outcomes.

Author

• Kejda Llana, University of Delaware
  Presenting Author