🔎︎
Research presented at the 2026 AMCP Annual Meeting in Nashville tracked the rapid evolution of state Medicaid fee-for-service coverage for GLP-1 receptor agonist-based anti-obesity medications following the approval of expanded medical indications. The poster, authored by Tran, Holderread, and Guest of IPD Analytics, received the Silver Award.
The investigators reviewed state Medicaid FFS websites at two time points, August 2024 and August 2025, to assess preferred drug list placement and prior authorization criteria for semaglutide and tirzepatide. The approvals of semaglutide for reduction of major adverse cardiovascular events and metabolic dysfunction-associated steatohepatitis, along with tirzepatide for obstructive sleep apnea, created new coverage obligations for state Medicaid programs because these indications fell outside the traditional weight-loss exclusion.
The analysis found a 76 percent increase in the number of states listing GLP-1 anti-obesity medications on preferred drug lists, rising from 17 to 30 states. At the same time, states maintaining prior authorization criteria specifically for chronic weight management decreased by 18 percent, from 22 to 18 states. As of August 2025, semaglutide was preferred in six states and tirzepatide in ten, with seven states preferring both agents. Among 18 states with active prior authorization criteria, ten imposed requirements beyond the labeled indication, such as higher BMI thresholds or extended lifestyle modification documentation.
Thirty-five states had established criteria for the cardiovascular risk reduction indication and 28 for obstructive sleep apnea. Eight states required step therapy on a preferred product before granting access to a non-preferred agent.
The authors noted that ongoing federal Medicaid spending reductions could push states to further narrow access for weight management alone or adopt single-preferred-product strategies.
