Rhode Island’s Medicaid program is contemplating an end to coverage for GLP-1 drugs prescribed for weight loss.
The proposal appears in the Rhode Island Executive Office of Health and Human Services’ 270-page operating budget submission for fiscal year 2027. The coverage change could take effect as early as July 1, 2026, but would more likely happen by October 2026 or January 2027, according to the budget request document — one of the many documents state agencies send to the governor’s office each fall with details on their monetary needs and challenges predicted in the upcoming fiscal year.
“While quite efficacious, these medications are quite expensive, with list prices ranging from $12,000 annually to roughly $16,000 annually as of March 2025,” the budget proposal reads.
The department’s proposal would only affect prescriptions for weight loss, and it would still cover prescriptions for diabetes, for which the GLP-1 drugs were first used to treat. GLP-1 drugs work on type 2 diabetes by suppressing glucagon, a hormone that raises blood sugar. The same mechanism plays a role in how the body feels hunger, which is why the drugs are valuable in weight loss.
The drugs are nearly chemically identical regardless of the condition they treat, and some drugs contain the same active ingredients but are marketed under different names. Novo Nordisk, for instance, markets two versions: Ozempic for diabetes and Wegovy for weight loss. Other branded drugs in the GLP-1 family include Trulicity, Mounjaro and Zepbound.
Regardless of branding, the drugs share a high price point as well, and are expected to get even pricier. The department estimates it could save $6.3 million in general revenue and $20.3 million across all funding sources, including federal ones.
The savings would be procured by tweaking contracts with managed care organizations (MCOs), the insurers who deliver most of the state’s Medicaid coverage.
“GLP-1 weight loss costs are expected to increase again between approximately 130 percent (low estimate) and nearly 200 percent (high estimate),” by the end of the second quarter in fiscal year 2027, according to the department’s budget request.
Between the start of fiscal year 2024 and the end of fiscal year 2025, GLP-1 costs roughly quadrupled in Rhode Island Medicaid’s per-member monthly payments to its managed care plans, according to the department.
That data aligns with what the Office of the Health Insurance Commissioner reported in May about the drugs’ impact on the commercial insurance market. A record 7.8% in spending growth in 2023 across Rhode Island’s health system was partially driven by a surging amount of GLP-1 prescriptions, which doubled from 2022 to 2023. Total commercial health plan spending on the drug class more than tripled from 2021 to 2023.
Health and Human Services’ budget note does, however, provide a caveat about its analysis of fiscal impact, which is based on a short-term calculation tied directly to changes in managed care rates.
“Ending coverage for GLP-1 obesity drugs would be in line with current financial trends in both public and private insurance companies but could result in health inequities and less comprehensive coverage for a large segment of Rhode Island’s population,” the budget note reads.
Obesity is more prevalent among low-income Rhode Islanders and communities of color. Among adults, 38.5% of Black residents have obesity, compared with 33.9% of Hispanic residents and 29.5% of white residents, according to Health in Rhode Island.
Income disparities are similar, with 44.6% of adults in households earning under $15,000 diagnosed as obese. Obesity is found in 35.5% of adults in households earning $15,000–$25,000.
Nationally, state Medicaid programs are restricting GLP-1 coverage as list prices consistently climb alongside increasing demand. The EOHHS note adds that 14 states cover GLP-1s, including Massachusetts, Connecticut, and New Hampshire.
But even these states may soon change their minds. Connecticut wants to roll back coverage, and Massachusetts’ MassHealth now limits weight-loss coverage to Zepbound with prior authorization. Patients must also take a trial of phentermine, an older drug chemically related to amphetamines and still widely used for weight loss, before they can be approved for GLP-1s.
The Health and Human Services budget document notes that the GLP-1 coverage chaos comes after the outgoing Biden administration left the specifics of the drugs’ eligibility under Medicare and Medicaid up to the Trump administration. In April 2025, President Donald Trump’s administration declined to expand Medicare Part D and Medicare Advantage plans to cover GLP-1s for weight loss.
This story was originally published by the Rhode Island Current.
