Expert Q&A: Michigan Medicaid’s new limits on GLP-1 weight management medications

Michigan’s state budget, passed in fall 2025, introduced a major change to Medicaid coverage that is designed to save the state money in 2026. This change could affect up to a million Michiganders with low incomes who are overweight or have obesity and will no longer qualify for coverage of a class of injectable weight management medications called glucagon-like peptide-1 receptor agonists, or GLP-1s.

A. Mark Fendrick, M.D., professor of internal medicine, and Lauren Oshman, M.D., M.P.H., clinical professor of family medicine—both University of Michigan Medical School faculty and Institute for Healthcare Policy & Innovation (IHPI) members—recently authored an op-ed published in the Detroit News calling attention to this issue and recommending the state legislature revisit their decision to restrict  coverage of GLP-1s. Without access to these treatments, they say, many will remain at risk for ongoing obesity and related health complications. 

What is Michigan Medicaid’s new policy for covering GLP-1 medications to treat overweight and obesity?  

Oshman: Effective January 1, 2026, Michigan’s Medicaid program, also known as the Healthy Michigan Plan,  began limiting coverage of GLP-1s for obesity treatment and long-term weight management. This is a significant change for our state, which was among the first to recognize that GLP-1s were important treatment options for Medicaid beneficiaries. Initial coverage for these medications began in early 2022 and required certain prior authorization criteria to be met, including adherence to a healthy lifestyle program. My colleagues and I actually provided data to help inform the state’s initial coverage decision.

GLP-1 medications (including Saxenda and its generic form liraglutide, Wegovy, and Zepbound) are now covered only for Medicaid beneficiaries whose body mass index (BMI) is equal to or greater than 40—defined as morbid obesity—and who meet strict prior authorization criteria. Even for this significantly restricted patient group, a physician must document that all other clinically appropriate weight loss interventions—such as the weight management medications phentermine and Qsymia—have failed, and attest that the use of a GLP-1 medication is necessary to avoid the need for higher-cost bariatric surgery. 

Notably, if beneficiaries not meeting these criteria came into 2026 already taking a GLP-1 weight management medication previously authorized by Medicaid (a substantial majority of users), their coverage will end when their six-month authorization period expires.  

As an alternative, Michigan Medicaid will cover phentermine and Qsymia (phentermine combined with topiramate) as preferred medications, although these lower-cost medications also require prior authorization criteria to be met.

Does Michigan Medicaid cover GLP-1 medications for the treatment of other health conditions?

Oshman: Yes. Coverage of individuals requiring treatment for type 2 diabetes will continue. Coverage is also authorized for specific GLP-1 medications to treat several other health conditions: Zepbound for people with moderate to severe sleep apnea, and Wegovy for individuals who are overweight or obese with established cardiovascular disease and for those with severe liver disease.

What effects will this new Michigan Medicaid policy change in GLP-1 coverage have?

Fendrick: From an economic perspective, the policy reducing coverage for GLP-1 medications will save the Michigan Medicaid program $240 million in 2026.

While these benefit changes yield savings that were deemed necessary to ensure our state’s financial stability, it is important to note a general rule that health spending cuts are almost always detrimental from a health perspective. In this case, up to one million Michiganders who are overweight or obese could lose coverage for GLP-1s, leaving them at risk for continued obesity and related health complications, including type 2 diabetes, heart disease, stroke, cancer, osteoarthritis, high blood pressure, high cholesterol, anxiety, depression, sleep apnea, asthma, gallbladder issues, and premature death. 

Will this policy change have an impact on already-existing health disparities?

Oshman: Yes, decreasing access to GLP-1 medications for Michigan Medicaid beneficiaries could worsen existing health disparities. This is because obesity and related chronic health conditions are more common among individuals with low socioeconomic status and those from racial and ethnic minority groups. 

The Medicaid program supports individuals with low incomes and those living with disabilities. This new policy change will affect these communities, which already face significant challenges in accessing health care. It is also worth noting that coverage of GLP-1s is limited for those insured by commercial plans and enrolled in Medicare. But while up to one-third of GLP-1 prescriptions being filled are paid for directly by patients outside of their insurance plans, my patients with Medicaid simply cannot afford to pay for these medications out of pocket. 

What do you suggest Michigan policymakers do to address these concerns?

Fendrick: We believe there are ways to control costs without broadly cutting access.  U-M School of Public Health alumnus and University of Chicago faculty member David D. Kim, Ph.D. and I have previously recommended adopting a more balanced, multipronged approach to GLP-1 medication coverage that “optimizes population health by maximizing the amount of weight loss—and associated clinical benefits—per dollar spent.” This approach recognizes that there are two distinct phases of obesity treatment—active weight loss and ongoing weight maintenance—and emphasizes that the most beneficial and cost-effective use of GLP-1s is during the active weight loss phase. Then, for ongoing weight management, patients may be able to switch to less expensive and potentially equally effective approaches. 

Oshman: This is why, in our op-ed, we encouraged the Michigan legislature to reconsider its decision to restrict access to GLP-1s within the state’s Medicaid program. We recommend adopting strategies that still meet state budgetary requirements but do not worsen public health to achieve similar cost savings. |

Fendrick: Part of what we’re recommending is to expand the focus beyond the cost of GLP-1 medications and consider bigger-picture approaches for reducing Medicaid expenditures. Specifically, we suggest using Medicaid payment strategies to reduce wasteful spending by decreasing the use of unnecessary services, such as those identified by professional clinical societies, while also making judicious use of GLP-1s. 

Oshman: We also note that not all mildly obese or overweight Michigan Medicaid beneficiaries need GLP-1 medication; many individuals can achieve their health goals through intensive lifestyle programs focused on diet and exercise or through less-expensive weight management medications. Moreover, most of the total spending on GLP-1s is dedicated to maintaining weight loss, not active weight loss. For some Medicaid beneficiaries who achieved their weight loss goals using GLP-1s, maintenance of weight loss could be managed with reduced or less-frequent dosing regimens, lower-cost weight management medications, behavioral therapy, and nutrition support. 

What is happening on the federal level at the same time this policy takes effect?

Fendrick: Several federal efforts are underway to make GLP-1 medications more affordable. In November 2025, the White House announced that its negotiations with GLP-1 manufacturers Eli Lilly (maker of Zepbound and Orforglipron) and Novo Nordisk (maker of Ozempic and Wegovy) will result in substantial price reductions for these drugs under the Most Favored Nation policy. This policy requires that the United States pay no more for prescription medications (including GLP-1s) than the lowest price paid by other high-income countries. Once the agreements are in place, the price of injectable GLP-1 medications will drop to approximately one-third of their current levels. 

In late December 2025, the Centers for Medicare and Medicaid Services (CMS) announced the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model, a new voluntary drug pricing model for Medicare Part D and Medicaid beneficiaries designed to increase access to GLP-1s and other healthy lifestyle interventions. Under this model, CMS will negotiate GLP-1 drug pricing and coverage terms with drug manufacturers on behalf of state Medicaid agencies and Medicare Part D plan sponsors. State Medicaid agencies can join the model beginning May 2026, and Medicare Part D plans in January 2027.

Finally, the Generating Cost Reductions for U.S. Medicaid (GENEROUS) model is scheduled to launch in January 2026 and run for five years. The model, which is voluntary for both manufacturers and states, empowers CMS to negotiate with drug manufacturers “to ensure fair and reasonable drug prices for Medicaid.”

Oshman: With all of this happening on the federal level to enhance access to these groundbreaking medications, we hope that our state lawmakers will be able to refine and revise the Medicaid coverage policy for GLP-1s to treat obesity. There is a lot at stake, and we risk being penny-wise and pound-foolish, as the old saying goes.