2028 candidates: What’s your GLP-1 plan?

GLP-1 drugs are medicines that mimic a natural gut hormone involved in blood-sugar control and appetite. They help the body release insulin when blood sugar rises, slow digestion, and reduce hunger. That makes them useful for treating Type 2 diabetes and, at higher doses or with specific products, obesity. Their rapid rise matters because obesity affects health and healthcare spending across the country.

Illinois Gov. JB Pritzker was diagnosed with Type 2 diabetes in 2024 and began taking insulin. A doctor later added a GLP-1. Pritzker lost about 80 pounds and no longer takes insulin. He also reported more energy and regular walks. His experience illustrates how one treatment can address both diabetes and weight.

The drugs are promising but expensive. About 32 million Americans take GLP-1s, and average annual medication spending is $1,528. Their wider use raises major questions about coverage, affordability, and whether improved health will eventually reduce medical costs.

Illinois changed its state employee health coverage in 2024. Previously, the plan covered GLP-1 drugs for diabetes. The state then expanded coverage to include obesity treatment. This matters because obesity coverage makes the drugs available for a broader medical need, rather than only for people with diabetes.

The coverage applies to Illinois state employees and their family members through the state employee plan. About 32,000 employees and relatives are currently taking the drugs. The state did not extend this benefit to Medicaid enrollees. The article does not give a more detailed clinical eligibility rule, such as a specific body-mass threshold or required prior treatment.

Illinois therefore offers a useful test case for wider coverage. The state is paying for a large group while monitoring health and financial results. Other states have taken different paths: seven that expanded Medicaid coverage for weight loss either dropped it or added restrictions this year.

GLP-1 use has reached a national scale, making cost a central healthcare and political issue. About 32 million Americans take the drugs. A 2024 KFF study found that more than 40% of privately insured Americans under 65 could be clinically eligible, depending on the expansion criteria. That potential population is much larger than current use.

Patients and health plans face different prices. Americans taking a GLP-1 spend an average of $1,528 per year, including people with and without insurance. Novo Nordisk advertises list prices of $149 to $399 per month for Wegovy and Ozempic, depending on dose. Cash payers may face particularly high costs, while insurance changes who pays the bill.

Illinois provides a concrete plan-level figure. About 32,000 state employees and family members cost the state $149 million, equal to 18% of its prescription budget. For comparison, other brand-name specialty drugs account for 41% of the budget.

When coverage expands from diabetes to weight loss, more people can receive treatment, so the immediate drug bill rises. That pressure reaches state budgets, employers, insurers, and Medicaid programs. The issue matters because obesity coverage could serve a very large population, while the drugs remain expensive and many patients may need long-term treatment.

Illinois reports the clearest example. About 32,000 state employees and family members take GLP-1s at a total cost of $149 million. That equals 18% of the state’s prescription budget. In private workplaces, CEOs and human-resources executives are balancing employee demand against the hit to their bottom line. Seven states changed or restricted Medicaid coverage after expanding it for weight loss.

The financial result is not settled. Pritzker says Illinois is monitoring savings from better health and believes they may defray part of the price. Medicaid cuts scheduled for next year are expected to worsen states’ budget problems, potentially encouraging tighter eligibility.

Preventing or reducing obesity-related illness could eventually lower healthcare spending. Better weight and blood-sugar control may reduce the personal and financial harms associated with chronic illness. Pritzker points to those broad costs, while Illinois is studying whether healthier members produce enough savings to offset expensive prescriptions. The article does not establish that savings have already exceeded drug costs.

The key mechanism is timing. A health plan pays for medication now, but possible savings may appear later through fewer or less costly health problems. Pritzker said Illinois believes those savings can at least defray part of the price. The state may be better positioned because many government employees stay for a reasonably long period.

Measurement remains difficult because the median US job tenure is about four years. The federal government evaluates health outcomes on a 10-year timetable. People may therefore switch employers or insurers before savings emerge, leaving one payer to fund treatment while another receives the later financial benefit.

Several policy choices could make GLP-1s more affordable, but they involve different trade-offs. Government negotiation could seek lower prices from manufacturers. Insurance requirements could require health plans to cover medically appropriate obesity treatment. Faster generic or biosimilar competition could also reduce prices after legal exclusivity ends. These are policy options, not all measures described as current policy in the article.

The article gives one active example: President Donald Trump pushed Eli Lilly and Novo Nordisk to lower prices. Manufacturers could also offer discounts or lower cash prices. Insurers might use eligibility rules, prior authorization, or negotiated rates to control spending, though tighter rules could reduce access. Public programs could set budgets while protecting people with the greatest medical need.

Affordability remains unresolved. Novo Nordisk advertises list prices from $149 to $399 per month for Wegovy and Ozempic, depending on dose. John Arnold argues that the class should be broadly available at a fair price because medicines cannot help people who cannot access them.

Insurance rules decide whether GLP-1 treatment is covered for diabetes, obesity, or both. Plans may also set clinical eligibility requirements or limit the benefit. Medicaid coverage is especially important: seven states that expanded coverage for weight loss either dropped it or added restrictions. Illinois expanded coverage for state employees but not Medicaid enrollees, creating different access by program.

Patents and related exclusivity can delay lower-cost generic or competing versions. Until competition arrives, manufacturers may retain pricing power, leaving patients and health plans to pay more. Faster competition could broaden access, but the article does not provide patent timelines or identify specific generic products. This is general healthcare-policy context rather than a reported detail from the article.

Job changes create another problem. The median US job tenure is about four years, while federal health evaluations use 10-year horizons. A worker may change plans before long-term benefits appear. One insurer pays for treatment, while a later insurer or public program may receive some savings.