Demand for GLP-1s from North Carolina Medicaid patients has grown significantly
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North Carolina is one of 13 states whose Medicaid programs cover GLP-1s for weight loss treatment, and their usage in the state has skyrocketed in recent years.
Why it matters: The number of Medicaid claims for GLP-1s as a prescription for weight loss surged from practically zero in 2023 to more than 211,000 in the past year, according to data from the N.C. Department of Health and Human Services.
- Medicaid coverage of GLP-1s for weight management began in August 2024. The drugs treat other conditions, including diabetes. Medicaid processed an additional 257,320 GLP-1 claims related to other conditions in North Carolina last year.
The big picture: More than 3 million North Carolinians receive health insurance through Medicaid, a program that provides health care for low-income patients.
- The program was expanded in 2023, adding another 700,000 North Carolinians, though the future of that expansion is not certain, after Congress slashed North Carolina's Medicaid funding last year by $50 billion, according to Gov. Josh Stein.
Between the lines: While the usage of these drugs provides many health benefits and helps bring down the nation's obesity rate, they come with a high cost and strain on budgets.
- In the past year, four states that were covering GLP-1s for weight loss for Medicaid patients dropped the coverage due to budget concerns, according to an analysis from KFF.
What they're saying: Elizabeth Williams, a senior policy manager with KFF's Program on Medicaid and the Uninsured, told Axios that last year, there was growing interest among states to offer GLP-1s to Medicaid patients for weight loss.
- But due to growing state budget constraints and Medicaid cuts in the Trump administration's One Big Beautiful Bill, "we are no longer seeing that interest in expanding coverage," Williams said.
State of play: North Carolina briefly rescinded coverage in 2025 because of a budget disagreement between the two Republican-led chambers of the N.C. General Assembly.
- The state made several cuts to its Medicaid coverage because of what DHHS saw as looming budget shortfalls.
- After several lawsuits, however, DHHS undid all those cuts, including for GLP-1s as a weight-loss treatment.
By the numbers: The cost of GLP-1s remains high, though Novo Nordisk and Eli Lilly, the two major producers of the drugs, have offered some reductions and discounts.
- The cost of all Medicaid claims for GLP-1s as a weight-loss treatment in North Carolina was nearly $273 million last year, according to DHHS.
Yes, but: That number does not include rebates and the federal share of funding that is returned to the state. Federal dollars generally cover between 65% to 90% of the cost of drugs in North Carolina, according to DHHS.
- Plus, GLP-1s tend to be cheaper in pill form. While only one such type is currently on the market, approval of other GLP-1 pills is expected in 2026.
Williams said it remains to be seen what will happen to the GLP-1 market in the coming year, though she noted the Trump administration did strike a deal aimed at reducing the costs of GLP-1s.
- "It's hard to say kind of what's going to happen to the GLP-1 market over time," she said. "Will we see prices come down? Will new drugs come into play? It's definitely evolving."