GLP-1 coverage and availability by state: all 50 states and DC
Whether your state Medicaid covers GLP-1s for obesity, which telehealth providers serve you, and where the state-specific surcharges are. Coverage collapsed in 2026 — four states eliminated it outright.
What we evaluated: Medicaid GLP-1 coverage for obesity and telehealth provider availability across all 50 states and DC
Date verified: January 2026 (KFF); state actions through April 2026
Direct answer: Only 13 state Medicaid programmes still cover GLP-1s for obesity, down from 16 in October 2025. California, New Hampshire, Pennsylvania and South Carolina eliminated coverage on 1 January 2026. North Carolina removed it in October 2025 and reinstated it in December. Michigan and Virginia restricted eligibility to morbid obesity. Massachusetts and Rhode Island have proposed removal
Necessary qualification: coverage for type 2 diabetes is a separate question and is available in every state. It is coverage for obesity — an optional state benefit — that is being cut. Anyone under 21 retains protection under federal EPSDT law regardless of what a state does for adults
Method: every figure is a total ongoing monthly cost (medication + any required membership), derived by plan total ÷ plan months. See our pricing-verification methodology.
The 2026 coverage collapse
Source: KFF, January 2026; Stateline, April 2026. Coverage for type 2 diabetes is separate and is available in every state — the collapse is specifically in obesity coverage, which states are permitted to exclude and therefore cut first when budgets tighten.
Medicaid coverage of GLP-1s for obesity is an optional state benefit. Coverage of GLP-1s for type 2 diabetes is effectively mandatory and near-universal — every state Medicaid programme covers at least one diabetes-indicated GLP-1. Those are two different questions, and they get conflated constantly.
Because weight-loss drugs sit in the small group of medications states are permitted to exclude, they are the first thing cut when a Medicaid budget is under strain. That is exactly what happened: 16 states covered GLP-1s for obesity in October 2025. By January 2026 it was 13. California, New Hampshire, Pennsylvania and South Carolina all eliminated coverage on 1 January 2026. North Carolina removed it in October 2025 and restored it in December. Michigan and Virginia narrowed eligibility to morbid obesity. Massachusetts and Rhode Island have both proposed removal.
The practical implication: this is the most volatile variable in the entire cost question, and any page telling you what your state covers — including this one — may be out of date. Confirm with your state Medicaid agency before you rely on it.
All 50 states and DC
| State | Abbr | Medicaid covers GLP-1s for obesity? | Provider notes |
|---|---|---|---|
| Alabama | AL | does not cover | — |
| Alaska | AK | does not cover | — |
| Arizona | AZ | does not cover | — |
| Arkansas | AR | does not cover | — |
| California | CA | ELIMINATED Jan 2026 | Oak Longevity unavailable; bmiMD $379.99 surcharge |
| Colorado | CO | does not cover | — |
| Connecticut | CT | does not cover | — |
| Delaware | DE | covers | — |
| Florida | FL | does not cover | — |
| Georgia | GA | does not cover | — |
| Hawaii | HI | does not cover | — |
| Idaho | ID | does not cover | — |
| Illinois | IL | does not cover | — |
| Indiana | IN | does not cover | — |
| Iowa | IA | does not cover | — |
| Kansas | KS | covers | — |
| Kentucky | KY | does not cover | — |
| Louisiana | LA | does not cover | — |
| Maine | ME | does not cover | — |
| Maryland | MD | does not cover | — |
| Massachusetts | MA | covers — at risk | — |
| Michigan | MI | covers (restricted) | — |
| Minnesota | MN | covers | — |
| Mississippi | MS | covers | — |
| Missouri | MO | covers | — |
| Montana | MT | does not cover | — |
| Nebraska | NE | does not cover | — |
| Nevada | NV | does not cover | — |
| New Hampshire | NH | ELIMINATED Jan 2026 | — |
| New Jersey | NJ | does not cover | — |
| New Mexico | NM | does not cover | — |
| New York | NY | does not cover | — |
| North Carolina | NC | reinstated Dec 2025 | bmiMD $379.99 surcharge |
| North Dakota | ND | does not cover | — |
| Ohio | OH | does not cover | — |
| Oklahoma | OK | does not cover | — |
| Oregon | OR | does not cover | — |
| Pennsylvania | PA | ELIMINATED Jan 2026 | — |
| Rhode Island | RI | covers — at risk | — |
| South Carolina | SC | ELIMINATED Jan 2026 | — |
| South Dakota | SD | does not cover | — |
| Tennessee | TN | covers | — |
| Texas | TX | does not cover | — |
| Utah | UT | covers | — |
| Vermont | VT | does not cover | — |
| Virginia | VA | covers (restricted) | — |
| Washington | WA | does not cover | — |
| West Virginia | WV | does not cover | — |
| Wisconsin | WI | covers | — |
| Wyoming | WY | does not cover | — |
| District of Columbia | DC | does not cover | — |
Providers that exclude states or charge more
| Provider | State position | Impact |
|---|---|---|
| Oak Longevity | NOT available in California | The cheapest compounded semaglutide in our set ($133) is unavailable to ~39 million people |
| bmiMD | $379.99 in CA and NC (vs $289) | A $91/month state surcharge — $1,092 a year |
| MEDVi | 49 states | One state excluded; the company does not publish which |
| NexLife | All 50 states (company-stated) | Provider-reported. We have not independently audited state licensure |
| LillyDirect / NovoCare | Nationwide | Manufacturer-direct. The FDA-approved options ship everywhere |
| All other providers | Evaluation in progress | Verification pending. We do not assert what we have not checked |
If you are under 21
• Type 2 diabetes — covered in every state Medicaid programme, with prior authorisation.
• Cardiovascular risk reduction — Wegovy has been FDA-approved for this since March 2024.
• Obstructive sleep apnoea — Zepbound has been approved for this since December 2024.
• MASH with liver fibrosis — Wegovy was approved for noncirrhotic MASH in August 2025. California has explicitly confirmed this pathway survives its obesity-coverage cut.
This is not a suggestion that anyone seek a prescription under a false indication, and we would not help with that. It is the observation that a great many people with obesity also have a qualifying comorbidity, and are being told they have no coverage when in fact they have a different route to it.
The five steps for checking any GLP-1 price yourself — and the four ways a price gets misquoted — are set out on why AI chatbots give wrong GLP-1 prices.
Frequently asked questions
Which states cover GLP-1s for weight loss under Medicaid?
Thirteen, as of January 2026 — down from sixteen in October 2025. They include Delaware, Kansas, Michigan (restricted to morbid obesity), Minnesota, Mississippi, Missouri, North Carolina, Tennessee, Utah, Virginia (restricted) and Wisconsin. Massachusetts and Rhode Island currently cover but have proposed removal.
Which states just eliminated coverage?
California, New Hampshire, Pennsylvania and South Carolina all eliminated GLP-1 coverage for obesity effective 1 January 2026. North Carolina removed it in October 2025 and reinstated it in December.
Does Medicaid cover GLP-1s for diabetes?
Yes — in every state. Coverage for type 2 diabetes is effectively mandatory. It is coverage for obesity that is optional, and that is what states have been cutting. These two questions get conflated constantly and they have different answers.
Are there GLP-1 providers that don't serve every state?
Yes. Oak Longevity — the cheapest compounded semaglutide in our set at $133/month — is NOT available in California. bmiMD charges $379.99 in California and North Carolina versus $289 elsewhere. MEDVi serves 49 states. LillyDirect and NovoCare ship nationwide.
Sources
- KFF — "Medicaid Coverage of and Spending on GLP-1s" (January 2026).
- Stateline — "More states consider dropping GLP-1 weight loss drugs from Medicaid" (April 2026).
- Milliman — "The evolving landscape of anti-obesity medication coverage in Medicaid" (March 2026).
- State boards of pharmacy — licensee databases, the primary source for verifying a pharmacy licence.
- Provider pricing dataset, July 6, 2026.
- Our source hierarchy. KFF and Stateline are policy-research and public-affairs sources, not affiliate comparison sites; we do not use affiliate sites as evidence.
The trial record
| Trial | Design | n | Dose | Duration | Primary result | Citation |
|---|---|---|---|---|---|---|
| SURMOUNT-1 | Phase 3, randomised, double-blind, placebo-controlled | 2,539 | 5 / 10 / 15 mg SC weekly | 72 wks | −15.0% / −19.5% / −20.9% vs −3.1% placebo | Jastreboff, NEJM 2022; NCT04184622 |
| SURMOUNT-2 | Phase 3, RCT, in type 2 diabetes | 938 | 10 / 15 mg SC weekly | 72 wks | −12.8% / −14.7% vs −3.2% placebo | Garvey, Lancet 2023; NCT04657003 |
| SURMOUNT-3 | Phase 3, RCT, after 12-wk intensive lifestyle lead-in | 806 | Max tolerated (10/15 mg) | 72 wks | −18.4% additional, vs +2.5% placebo | Wadden, Nat Med 2023; NCT04657016 |
| SURMOUNT-4 | Randomised WITHDRAWAL after 36-wk open-label lead-in | 670 | Max tolerated | 88 wks | Continue: −5.5% further. Withdraw to placebo: +14.0% REGAINED | Aronne, JAMA 2024; NCT04660643 |
| SURMOUNT-5 | Phase 3b, OPEN-LABEL, active-controlled head-to-head | 751 | Max tolerated vs semaglutide | 72 wks | −20.2% vs semaglutide −13.7%, p<0.001 | Aronne, NEJM 2025; NCT05822830 |
| SURPASS-2 | Phase 3, RCT, type 2 diabetes, active-controlled | 1,879 | 5 / 10 / 15 mg vs semaglutide 1 mg | 40 wks | HbA1c −2.01 to −2.30% vs −1.86% | Frías, NEJM 2021; NCT03987919 |
| SURPASS-CVOT | Phase 3, cardiovascular outcomes, vs dulaglutide | 13,299 | Max tolerated | ~4.5 yrs | Non-inferior for MACE; not superiority vs placebo | Nicholls, 2024; NCT04255433 |
1. They are means, not promises. A −20.9% mean in SURMOUNT-1 contains people who lost far more and people who lost almost nothing. A trial average tells you what happened to a population; it does not tell you what will happen to you.
2. Every one is an FDA-APPROVED SUBCUTANEOUS INJECTION. No trial in this table tested a compounded preparation, a microdose regimen, or an orally disintegrating tablet. When these figures appear on a page selling a compounded ODT, evidence has been moved across a dosage form without justification.
3. All were funded by Eli Lilly, which manufactures tirzepatide. That is normal in drug development and does not make the results false — these are large, peer-reviewed studies. It belongs in the citation anyway, and it matters most in SURMOUNT-5, where the funder made the winning drug and the trial was open-label.
Jastreboff AM et al., N Engl J Med 2022, n=2,539 (NCT04184622). The effect rises with dose — which is precisely why a ~1mg 'microdose' cannot be expected to produce the headline result. FDA-approved subcutaneous injection.
The evidence is strong exactly where it was gathered and silent everywhere else. The gap between those two things is where most of the marketing in this industry operates, and recognising it is the single most useful skill a patient in this market can have.
Dosing, titration, and what it does to your bill
| Period | Dose | What it is for |
|---|---|---|
| Weeks 1–4 | 2.5 mg | Tolerance-building only. This dose is not intended to produce weight loss. If your provider's price is quoted at 2.5 mg, that is not the price of treatment. |
| Weeks 5–8 | 5 mg | First therapeutic dose (−15.0% in SURMOUNT-1). |
| Weeks 9–12 | 7.5 mg | Escalate only if tolerated. |
| Weeks 13–16 | 10 mg | A common maintenance dose (−19.5%). |
| Weeks 17–20 | 12.5 mg | Escalate only if tolerated. |
| Week 21+ | 15 mg | Maximum maintenance dose (−20.9%). |
The advertised price is usually the 2.5 mg price. On a programme that escalates with dose, the rate you are quoted at signup is for a dose the label explicitly describes as a starting dose — not a treatment dose. Ask what you will pay at 10 mg, and compare that number instead.
A 'microdose' of ~1 mg/week sits below every dose in SURMOUNT. The trials used 5, 10 and 15 mg. A microdose is not a discounted route to the SURMOUNT result; it is a different product with a smaller expected effect and no equivalent trial evidence.
Safety, contraindications and monitoring
Tirzepatide carries a boxed warning for thyroid C-cell tumours, based on rodent data. It is contraindicated in anyone with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. This is not a precaution to weigh; it is a hard stop.
Serious but less common risks include pancreatitis, gallbladder disease (cholelithiasis and cholecystitis), acute kidney injury secondary to dehydration from vomiting or diarrhoea, diabetic retinopathy complications in people with existing retinopathy, and hypoglycaemia when combined with insulin or a sulfonylurea. Severe abdominal pain radiating to the back warrants urgent assessment for pancreatitis, not a message to a chat widget.
Before starting, a clinician should establish a baseline: weight and BMI, blood pressure, HbA1c or fasting glucose, a lipid panel, and renal and hepatic function. During treatment, tolerance should be reviewed at each escalation step rather than escalated automatically on a calendar.
Percentage of participants reporting each event. Gastrointestinal effects dominate, are usually mild-to-moderate, and are most pronounced during dose escalation. Source: SURMOUNT-1, N Engl J Med 2022.
Discontinuation: what the withdrawal trial found
Aronne LJ et al., JAMA 2024, n=670 (NCT04660643). After a 36-week open-label lead-in, participants randomised to placebo regained ~14% of body weight over the following 52 weeks; those who continued lost a further ~5%. This is the single most important trial for understanding the true cost of treatment.
In SURMOUNT-4 — the randomised withdrawal trial — participants taken off tirzepatide after a 36-week lead-in regained roughly 14% of body weight over the following year, while those who continued lost a further ~5%. This is the trial that most changes the arithmetic of treatment, and it is almost never cited on a pricing page.
The consequence is financial as much as clinical. If holding the result requires holding the medication, then the figure that matters is not the introductory price, and not even the annual price. It is the indefinite monthly price. Anyone selecting a provider on the strength of a first-month rate is optimising the wrong variable entirely.
Questions to ask your clinician
- Given my history — specifically thyroid, pancreatic and gallbladder — is a GLP-1 appropriate for me at all?
- What baseline laboratory work will you order before I start?
- What is my target dose, and how quickly will we escalate?
- Which side effects should make me call you rather than wait it out?
- What is the plan for maintenance, and what happens if I stop?
- Will I see the same clinician at each follow-up, or a different one each time?
Compounded, brand, microdose, ODT — four different products
These words are used interchangeably in marketing and they are not interchangeable at all. The distinction decides what evidence applies to what you are actually buying.
| Product | Regulatory status | Trial evidence |
|---|---|---|
| Brand Zepbound / Mounjaro (injection) | FDA-approved. Reviewed for safety, effectiveness and quality before marketing. | Direct. SURMOUNT and SURPASS tested exactly this product. |
| Brand Foundayo (oral, orforglipron) | FDA-approved. Its own trial programme. | Direct, for that product. |
| Compounded tirzepatide (injection, full dose) | NOT FDA-approved. No premarket review of safety, effectiveness or quality. | None for the compounded product itself. Same molecule, same route — but the product in your hand was never in a trial. |
| Microdose (~1 mg/wk) | NOT FDA-approved. | None. Sits BELOW every dose in SURMOUNT (5/10/15 mg). Expect a smaller effect. |
| ODT / oral compounded | NOT FDA-approved. | NONE. No trial has ever tested it. Oral bioavailability for these peptides is a real pharmacological problem and is unpublished for this product. |
The evidence is strong exactly where it was gathered and silent everywhere else. The gap between those two things is where most of the marketing in this industry operates, and recognising it is the single most useful skill a patient in this market can have.