State Medicaid programs reimbursed 11.0 million GLP‑1 prescriptions in 2025

Across 51 reporting state Medicaid programs, Medicaid reimbursed 10,994,383 GLP-1 prescriptions in 2025 and recorded $11.9 billion in total reimbursement for them.1 That is $1,081 per prescription on average. CMS publishes these rows one drug code, one state and one quarter at a time — 8,939 rows across 40 drug codes for this year alone — and publishes no national total. This is that total.

The quarters run Q1 at 2,432,899, Q2 at 2,582,707, Q3 at 3,033,748 and Q4 at 2,945,029.1 From the first quarter to the fourth that is a rise of 512,130 prescriptions, or 21.1%. The growth is inside a single year of one payer's data, which is worth holding onto: a year-total quoted without it reads as a plateau when the underlying series is still climbing.

CMS has since published Q1 2026: 2,362,665 prescriptions, against 2,432,899 in Q1 2025 — down 2.9% year on year.1 One quarter is not a trend, and early quarters are revised upward as states report late, so treat this as the first reading rather than the direction of travel.

By molecule the year splits as Semaglutide 5,885,301, Tirzepatide 3,116,061, Dulaglutide 1,910,882, Liraglutide 79,343 and Exenatide 2,796.1 Semaglutide alone accounts for 53.5% of prescriptions and $6.6 billion of reimbursement. Medicaid's GLP-1 bill is concentrated in a small number of molecules, so a formulary decision on one of them moves the national total more than any change in prescribing volume across the rest.

California (3,077,835), Pennsylvania (842,416), New York (810,636), Michigan (606,749) and North Carolina (483,131) together reimbursed 5,820,767 of the 10,994,383 prescriptions.1 State Medicaid programs set their own GLP-1 coverage rules, so this distribution reflects coverage policy and enrolment size at once, and the two cannot be separated in this file. A state that covers GLP-1s for weight management will sit far above a similarly sized state that covers them only for diabetes.

Divided by the Census Bureau's July 1, 2025 resident population, Medicaid reimbursed 3,217 GLP-1 prescriptions per 100,000 residents nationally, $34.78 of reimbursement per resident.1,2 California filled the most per resident at 7,821 per 100,000 and North Dakota the fewest at 380, a 20.6 times gap. Size and rate are different questions: of the five most populous states, California ranks 1 of 51 at 7,821, Pennsylvania ranks 2 of 51 at 6,451, New York ranks 14 of 51 at 4,053, Florida ranks 46 of 51 at 566 and Texas ranks 48 of 51 at 538. The rate is per resident, not per Medicaid enrollee, so it mixes enrolment, coverage policy and prescribing, and the table below carries every state's figure.

CMS suppresses cells built on fewer than eleven prescriptions to protect patient privacy, and flags them in the file. 1,970 of the 8,939 rows for 2025 are flagged.1 Suppressed rows contribute nothing to the sum, so every figure on this page is a floor rather than an exact count. The effect is largest in small states and on low-volume drug codes, and it is why we publish the number as computed rather than grossed up to an estimate.

Prescriptions are the CMS state totals for calendar year 2025; spend is the total Medicaid reimbursed for them. Both are divided by the Census Bureau’s July 1, 2025 resident population, so a large state and a small one read on one scale. Names link to the state page where one is published.

CMS publishes State Drug Utilization Data as one row per drug code, per state, per quarter, per utilization type.1 We ingest the rows for the GLP-1 codes we track and sum the prescription-count column over calendar year 2025. The dollar figures are the total reimbursed column, which is the full reimbursed amount including the non-Medicaid share where the file carries one.

A prescription here is one reimbursed fill, not one patient and not one course of treatment. Someone filling monthly appears twelve times in a year. No de-duplication is possible in this file, and none is attempted.

The per-resident rates divide each state's totals by the Census Bureau's Vintage 2025 estimate of its resident population on July 1, 2025, the latest annual estimate.2 The denominator is every resident, not every Medicaid enrollee: a per-enrollee rate would need CMS's monthly enrollment reports, which this page does not yet join. The national rate is the state sum over the summed population of the 51 state programs with a population on file.

This is Medicaid only. Commercial insurance, Medicare and cash purchases are not in this data at any volume, so nothing here should be read as national GLP-1 use. Medicare's side of the same question is on the Part D spending page.

Each of these changes what the figure means. They are numbered so a quotation can name the one it breaks.

1. Counts cover prescriptions Medicaid reimbursed. Cash, commercial and Medicare prescriptions are not in this data.
2. CMS suppresses small cell counts, so state totals are floors, not exact counts.
3. A prescription here is one reimbursed fill, not one patient.
4. The rates are per resident, not per Medicaid enrollee. A state’s rate reflects how many of its residents are on Medicaid, whether its program covers GLP-1s for obesity as well as diabetes, and prescribing, and this data cannot separate the three.
5. Delaware’s reimbursement works out to about a third of the national average per prescription, which points to a units or reporting artefact in the state’s rows. Quote Delaware’s prescription count, not its dollar figure.