ArticleJAMA health forum2026
GLP-1 Receptor Agonist Coverage for Obesity in Medicaid and Total GLP-1 Receptor Agonist Utilization.
Article in JAMA health forum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Importance: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for treating obesity, but few Medicaid programs cover them due to cost concerns with accelerating utilization. However, potential substitution effects between obesity-labeled GLP-1 RAs and diabetes-labeled GLP-1 RAs, which have identical active ingredients and which all states cover, are not well understood. Objective: To determine whether Medicaid coverage of obesity-labeled GLP-1 RAs is associated with obesity-labeled, diabetes-labeled, and total GLP-1 RA utilization. Design, Setting, and Participants: This cross-sectional study used US state-level Medicaid drug utilization data from 2021 to 2024. Synthetic difference-in-differences was used to assess the association of obesity-labeled GLP-1 RA coverage with GLP-1 RA utilization. Exposure: Medicaid program coverage of obesity-labeled GLP-1 RAs. Main Outcomes and Measures: The primary outcome was aggregate quarterly prescriptions per 1000 beneficiaries; secondary outcomes included prescription-months (accounting for duration of fills) and Medicaid reimbursement per 1000 beneficiaries. Results: Of 9 states (n = 89 021 657; mean [SD] of 49.4% [0.5%] were male, 50.6% [0.5%] were female) that began Medicaid coverage of obesity-labeled GLP-1 RAs between 2021 and 2024 and 36 control states (n = 212 786 953; mean [SD] of 49.8% [0.9%] were male, 50.2% [0.9%] were female), overall and diabetes-labeled GLP-1 RA utilization increased substantially in both groups, whereas obesity-labeled GLP-1 RA increased significantly only in treated states. Estimates from synthetic difference-in-differences models demonstrated a mean increase in obesity-labeled GLP-1 RA of 6.48 prescriptions per 1000 beneficiaries (95% CI, 4.00-8.96; P < .001), with estimates increasing nearly each quarter after Medicaid coverage was implemented. By contrast, changes in total GLP-1 RA prescriptions compared with obesity-labeled prescriptions were not statistically significant (4.17 per 1000 beneficiaries [95% CI, -0.33 to 8.67; P = .07]), nor were those for diabetes-labeled GLP-1 RA prescriptions (-2.16 prescriptions per 1000 beneficiaries [95% CI, -5.27 to 0.96; P = .17]). In the subgroup of states with prior authorization requirements more restrictive than the Food and Drug Administration label, there was a significant relative decrease in diabetes-labeled GLP-1 RA utilization of 3.02 prescriptions per 1000 beneficiaries (95% CI, -5.69 to -0.36; P = .03). Conclusions and Relevance: Results of this study suggest that substitution effects are possible between obesity-labeled and diabetes-labeled GLP-1 RAs, varying by state coverage policies, that could impact coverage decisions.
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