State Medicaid Utilization and Gross Spending on Anti-Obesity GLP-1 Receptor Agonists, 2021–2025: a state × quarter × brand panel from State Drug Utilization Data with NDC-level brand resolution

A state × quarter × brand panel of United States Medicaid utilization and gross (pre-rebate) reimbursement for every anti-obesity GLP-1 receptor agonist brand (Wegovy, Zepbound, Saxenda, weight-management-indicated generic liraglutide, and Foundayo/orforglipron, which is monitored with no utilization yet), built from the CMS State Drug Utilization Data (SDUD) 2021 to 2025 plus the partial 2026 file, pulled 2026-07-22. Because semaglutide, tirzepatide, and liraglutide are each marketed under separate obesity and diabetes brand names, only 11-digit NDC-level extraction can isolate anti-obesity use; diabetes-indicated brands (Ozempic, Rybelsus, Mounjaro, Victoza, and others) are excluded by NDC, never by name matching.

The panel (year × quarter × state × brand × utilization type) reports prescriptions, units, gross reimbursement, and Medicaid-paid amounts, with per-cell counts of CMS's suppressed small cells (counted, never imputed). Companion files provide the national quarterly series, a per-quarter jurisdiction-adoption series, the 2025 state league table, the frozen brand-to-NDC appendix with per-NDC provenance (including 12 delisted package NDCs recovered by an SDUD-side completeness sweep), a suppression/completeness audit (state sums capture at least 99.6% of CMS's national aggregate rows for the major brands), and the complete standard-library Python pipeline for reproduction. FDA approval dates for every cohort brand and indication expansion (Wegovy cardiovascular risk reduction, 2024; Zepbound obstructive sleep apnea, 2024) were verified against Drugs@FDA approval letters at build time.

Headlines: Medicaid anti-obesity GLP-1 gross spending grew from $24.7 million (2021) to $4.44 billion (2025) across 3.75 million prescriptions; jurisdictions reporting any Wegovy utilization grew from 17 (Q4 2023) to 47 (Q4 2025); Zepbound surpassed Wegovy in Q4 2025; California accounted for 47% of national 2025 gross spending. All dollar figures are gross, because Medicaid rebates are confidential and unobservable in SDUD, so the figures are ceilings on net state cost.

Sources are public domain (CMS SDUD; openFDA NDC Directory); this analysis is independent and not endorsed by CMS or FDA. Drug-level Medicaid utilization context is also displayed on HelloPharmacist drug pages. Released under CC BY 4.0.