Medicaid reimbursed at least $11.95 billion for GLP‑1 drugs in 2025, before rebates. California paid $3.46 billion of it.

CMS publishes one row per drug code, per state, per quarter.1 We sum the column total_amount_reimbursed for 40 GLP-1 drug codes across the four quarters of 2025.2 The drugs are Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound, Trulicity, Victoza, Saxenda and Byetta.1

The total holds two parts. Medicaid itself paid $11.73 billion.2 Other payers on the same claims paid $213.1 million, which is 1.8% of the total.2

The total covers 11,049,588 reimbursed prescriptions.2 A prescription here is one fill, not one patient.

Most of these drugs treat type 2 diabetes. This data does not say why a drug was prescribed, so the total is not a weight-loss figure.

It is before rebates. Drug makers pay rebates to the states after the pharmacy is reimbursed, and the utilization data does not show them.3 The net cost to Medicaid is lower than $11.95 billion.2 CMS does not publish the rebate per drug, so nobody outside the program can compute the net figure.3

It is a floor. CMS hides the values in small cells to protect patient privacy.1 In the state rows for 2025, CMS suppressed 1,970 of 8,939 rows, or 22.0%.2 A suppressed row adds nothing to a sum. Every state total on this page is therefore a minimum, not an exact count.

CMS suppresses less at the national level: 26 of the 280 national rows.2 The national rows carry $8.7 million more than the state rows and Puerto Rico added together.2 Puerto Rico reported $50.4 million.2

The 50 states and DC sum to $11.89 billion.2 The shares in the table below use that sum as the base. The last column shows how many of the state's rows CMS suppressed.

Five states hold 55.6% of the state sum: California, Pennsylvania, New York, Michigan and North Carolina.2 The top 10 hold 70.1%.2 The bottom 10 hold 1.5%.2

California's total is 3.6 times Pennsylvania's, the state in second place.2 California runs the largest Medicaid program in the country, so a large total is expected. This ranking is in dollars, not dollars per resident. Do not read it as a measure of how generous a state is.

Twenty-two states passed $100 million.2 Seventeen states stayed under $50 million.2 Texas ranks 17th with $178.1 million and Florida ranks 21st with $127.7 million.2 Both are large states with small totals. Population alone does not set the order.

Source for every row: CMS rows, summed by glp1.health.1,2

Read the bottom of the table with care. Wyoming shows $2.2 million, but CMS suppressed 55 of its 115 rows.2 North Dakota shows $2.5 million with 50 of 76 rows suppressed.2 Arkansas shows $15.4 million with 88 of 218 rows suppressed.2

Suppression hits small cells, so it hits small states hardest. The true totals for these states are higher than the table shows. We cannot say by how much.

At the top of the table the effect is small. California lost 17 of 233 rows.2

National reimbursement rose through the first three quarters and then eased.2

The third quarter was 26.3% above the first.2 CMS revises recent quarters as states file late claims, so the fourth-quarter figure can still move.1

Semaglutide took 55.3% of the national total and tirzepatide took 27.8%.2 Exenatide rounds to zero.2

Use this sentence: "Medicaid reimbursed at least $11.95 billion for GLP-1 drugs in 2025, before rebates, according to CMS State Drug Utilization Data summed by glp1.health."2

Keep "at least" and "before rebates" in the sentence. Without them the number is wrong.

For the Medicare side, see Medicare Part D GLP-1 spending.