Medicaid Coverage Withdrawal and Dispensing of Glucagon-Like Peptide-1 Receptor Agonists for Obesity

Introduction: Five state Medicaid programs withdrew coverage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for obesity in late 2025 and January 2026, and others have narrowed coverage or are reconsidering it.The benefits of these drugs appear to depend on continued use, but whether withdrawal interrupts treatment for current users is unknown.This study examined changes in dispensing of obesityindicated GLP-1 RAs after state Medicaid programs withdrew or restricted coverage.Methods: This quasi-experimental study used quarterly Medicaid State Drug Utilization Data for 50 states and the District of Columbia from 2021 through the first quarter of 2026.Difference-in-differences and event-study models compared dispensing in states that withdrew coverage with dispensing in states that continued it, using each state's dispensing of diabetes-indicated GLP-1 RAs as a within-state comparison.The exposure was withdrawal or restriction of Medicaid coverage of GLP-1 RAs for obesity, identified from state agency documents.The main outcome was reimbursed prescriptions for obesity-indicated GLP-1 RAs per 1,000 enrollees per quarter.Estimates are reported with 95% confidence intervals (CIs).Data were analyzed from September to October 2026.Results: The five withdrawing states accounted for 2,428,709 (65.2%) of 3,725,732 obesity-indicated GLP-1 RA prescriptions reimbursed by Medicaid in 2025.Compared with 12 continuing states, withdrawal was associated with an 84.7% decline in obesity-indicated dispensing (95% CI: 64.5%-93.4%;exact permutation p < 0.001), or 29.1 fewer prescriptions per 1,000 enrollees per quarter (95% CI: 14.3-43.9).No significant change was detected in diabetes-indicated dispensing (-3.2%; 95% CI: -23.4% to 22.2%), and differences between the two groups before the withdrawals were announced were small and not statistically significant.In the first quarter without coverage, obesity-indicated dispensing fell by 61% to 96% in individual withdrawing states.The four states that withdrew on January 1, 2026, reimbursed 661,353 obesity-indicated prescriptions in the preceding quarter and 134,647 in the next, a decline of 526,706 (79.6%).Dispensing of older antiobesity medications increased by at most 2.9 prescriptions per 1,000 enrollees.Narrower criteria in two states were followed by declines of 23%-37%.Conclusions: In this quasi-experimental study, withdrawal of Medicaid coverage was associated with the loss of most reimbursed dispensing of GLP-1 RAs for obesity within one quarter, with little replacement by other agents.Protecting enrollees already receiving these drugs, for example, by honoring existing authorizations, might limit treatment interruption, but this has not been evaluated.