KEY DETAILS
California Medicaid prescriptions for Wegovy, Zepbound and Saxenda fell from 523,015 in Q4 2025 to 126,912 in Q1 2026 (data dated March 31, 2026).
North Carolina Medicaid spending on GLP-1 drugs rose to $145.7 million in Q1 2026, up from $89.6 million in Q4 2025 (data dated March 31, 2026).
Missouri Medicaid spending on GLP-1 drugs rose to $121.2 million in Q1 2026, up from $102.2 million in Q4 2025 (data dated March 31, 2026).
Nationwide Medicaid spending on GLP-1 drugs fell 20% from Q4 2025 to $2.58 billion for 2,412,872 prescriptions in Q1 2026 (data dated March 31, 2026).
Trulicity is on the CMS selected drug list for Medicare price negotiation, per a CMS update dated January 27, 2026, with any negotiated price taking effect January 1, 2028.
Medicaid data from the Centers for Medicare and Medicaid Services, covering the first quarter of 2026, shows GLP-1 spending moved in different directions depending on the state. Some states paid out much less than they did the previous quarter, while others paid out noticeably more. These are Medicaid spending and prescription figures, and the amounts are what Medicaid reimbursed pharmacies before manufacturer rebates. Here is what the numbers show, state by state and nationwide.
The swing in California is hard to miss. California's Medicaid drug utilization data for the first quarter of 2026 is dated March 31, 2026. Prescriptions for Wegovy, Zepbound and Saxenda fell from 523,015 in Q4 2025 to 126,912 in Q1 2026. That is a steep drop in just one quarter. California's total Medicaid GLP-1 spending fell from $989.6 million in Q4 2025 to $537.6 million in Q1 2026, and its total GLP-1 prescriptions fell from 882,881 to 498,483.
Not every state moved the same direction. North Carolina's Medicaid program reported GLP-1 spending of $145.7 million for Q1 2026, dated March 31, 2026. That is up from $89.6 million in Q4 2025. North Carolina was named one of the five highest-spending states for GLP-1 medicines in Medicaid in Q1 2026.
Missouri followed a similar path. Missouri's Medicaid program reported GLP-1 spending of $121.2 million for Q1 2026, dated March 31, 2026, up from $102.2 million in Q4 2025. Missouri was also named one of the five highest-spending states for GLP-1 medicines in Medicaid in Q1 2026.
Put the states together and the national trend looks different from some of the individual stories. Medicaid paid $2.58 billion nationwide for 2,412,872 GLP-1 prescriptions in Q1 2026, dated March 31, 2026. That is a 20% drop in dollars from the $3.22 billion Medicaid paid for 3,012,864 prescriptions in Q4 2025. The overall direction, in other words, was down.
There is also a separate Medicare item. Trulicity is on the CMS selected drug list for Medicare price negotiation, and CMS's most recent update to its entries is dated January 27, 2026. Any negotiated price would take effect on January 1, 2028, and CMS has not yet posted a negotiated price. The negotiated price applies to Medicare Part D and is not a patient copay.
The figures come from the CMS State Drug Utilization Data for Medicaid, and the Trulicity item comes from the CMS Drug Price Negotiation Program. The amounts are before manufacturer rebates, so you can compare the exact numbers directly with the CMS data.
Originally published on GLP1Laws.
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