This story was originally published by CalMatters. Sign up for their newsletters.
Laura Richardson pays $450 a month out of pocket for a drug that could keep her off insulin for the rest of her life. She’s a California state senator — and even she can’t get her own insurance to cover it.
Richardson started using a GLP-1 a year ago after learning she was pre-diabetic. Her state health plan does not cover it.
“If something is available to help you to be more healthy, to avoid comorbidities … why would we want to wait till a person became diabetic to help them?” she told lawmakers in a June hearing.
Her experience is not unusual. For many Californians, popular weight loss drugs such as Ozempic and Wegovy continue to be elusive despite their clinical promise. While prices are dropping, these drugs continue to be unaffordable for many; most insurers don’t cover them; and state programs, wary of costs, have rolled back access.
Senate Bill 1089, which would expand access to the class of drugs known as GLP-1s, is clearing its final hurdles this legislative session. The bill would direct the state to seek to partner with a drug manufacturer to increase competition and lower prices for GLP-1s under its CalRx program, a state program created to distribute popular, expensive drugs at a fraction of the cost.
It is unclear how long that could take, but it’d likely be a yearslong endeavor. It took the state three years to bring its $55 insulin into the market under CalRx. Today the state program also distributes albuterol inhalers and naloxone.
Richardson, an Inglewood Democrat, authored the bill, which is a watered-down version of its original, more ambitious form. Previously, the bill also sought to require that CalPERS, the health plan that insures 1.3 million public employees and retirees, cover GLP-1 drugs.
CalPERS opposed the bill and argued that the drug’s high cost would increase premiums by $28 per member per month.
Richardson added that she had discussed including GLP-1s in the CalRx program with the governor, and “he was very positively open to that.” State health officials have said that GLP-1s are among the drugs they are considering for the program.
A boom in GLP-1 spending
The bill follows California’s recent elimination of GLP-1 coverage for the treatment of obesity in its Medicaid program, known as Medi-Cal. The state cited growing pharmacy costs and budget pressures for cutting the benefit. The state still pays for certain GLP-1s when prescribed specifically for diabetes treatment.
GLP-1s have helped many people to better manage their obesity and chronic healthcare conditions. Obesity is a well-known contributor to conditions such as diabetes and cardiovascular disease.
State data show that the number of GLP-1 prescriptions solely for weight loss jumped from 20,000 to 700,000 between 2018 and 2023 across both Medi-Cal and commercial plans. In 2023, California spent $416.8 million on GLP-1 prescriptions for weight loss in the Medi-Cal program and commercial payers spent $405.2 million, according to state data.
An analysis by the Legislative Analyst’s Office found that during this time, California’s pharmacy spending nearly doubled, and tied that growth to drugs that treat diabetes, obesity, and inflammatory diseases.
California is not the only state feeling the burden of these drugs’ popularity and cost: New Hampshire, Pennsylvania, Massachusetts and South Carolina also recently eliminated Medicaid coverage for GLP-1s when used solely for weight loss.
Today 12 states cover GLP-1s for obesity treatment under their Medicaid programs, although Rhode Island will cease coverage in October.
Similarly, coverage of GLP-1s under private insurance varies widely; there’s no clear standard. Health plans have also pointed to costs , noting they are currently a key contributor to premium increases.
Alison Sexton Ward, an economist and research scientist at the University of Southern California, said that data show huge benefits for peoples’ health. Modeling projects long-term savings in healthcare spending as well as a narrowing of health disparities, but she noted it’s a tricky investment for insurers to make. There are significant upfront costs before plans may start to see savings because of the reduction of obesity-related health problems, and insurers may not capture those savings when people tend to switch health plans every few years, she explained.
“The thing about treating obesity is just because you lose weight today doesn’t mean that your healthcare costs go down tomorrow,” Ward said. “There’s been this unique pressure on these drugs that they pay for themselves.”
One pilot that researchers and providers are looking at is the new federal Medicare GLP-1 Bridge Program, a temporary project that seeks to bring down the cost of Zepbound, Wegovy and Foundayo to about $50 a month.
Patients seeking cheaper options
Dr. Wayne Ho, an obesity specialist and researcher in Los Angeles, sees the consequences of patchwork access to the drugs in his patients. Patients who can pay cash or whose insurance covers the drugs tend to be able to better manage their health conditions. Those without access try other, less effective therapies.
“It’s really disheartening to see because we have these wonderful innovative treatments that really are life altering,” he said.
The cost is also driving some of his patients to seek cheaper, compounded versions of the drug, which some doctors warn against because they lack FDA approval.
Compounding typically involves custom-making a drug for a specific need — removing an allergen, for example. Increasingly, compound pharmacies and telehealth platforms are offering versions of GLP-1s that swap out an ingredient or two. Ho says these compounded drugs carry higher risk because they bypass the FDA’s rigorous vetting and approval process.
Nationally, calls to poison centers related to weight loss drugs increased by 1,500% between 2019 and 2025, according to data from America’s Poison Centers. Studies and reports have shown that compounded GLP-1s are more likely to cause adverse effects and have a higher risk of preparation errors. A Binghamton University study found that the odds of hospitalization were higher for compounded products. The FDA also warns of the prevalence of counterfeit products.
Ho calls GLP-1s one of the best tools he has as a provider. He remains hopeful that affordable access to the FDA-approved weight loss drugs is on the horizon. Continued efforts by state lawmakers to expand access are a critical step, he said.
“I think there’s more and more pressure to cover these medications as more and more scientific data come out to show how it affects the body in a very positive manner,” he said.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.