Does Ambetter cover GLP-1s?

What Ambetter Health (Centene) says on its own pages (ambetterhealth.com), sorted by topic. Your own plan documents decide what you get.

Read Sep 28, 2026. Each line names the plan type it applies to.

Does it cover GLP-1s for weight loss?

Ambetter from Arkansas Health & Wellness member news dated 11/21/25 says Ambetter does not currently cover GLP-1s prescribed solely for weight management.Individual (ACA) plans:While these drugs have also shown effectiveness in supporting weight loss, it’s important to understand that Ambetter does not currently cover GLP-1s when prescribed solely for weight management.ambetterhealth.com, Sep 29, 2026
Ambetter from Superior HealthPlan (Texas) policy updates effective March 1, 2026: under Wegovy policy CP.PMN.295, use of Wegovy (or NN9932) for weight management is a benefit exclusion and will not be authorized.Individual (ACA) plans:Use of Wegovy or NN9932 for the treatment of weight management is a benefit exclusion and will not be authorized.ambetterhealth.com, Sep 29, 2026
Ambetter Arkansas provider news dated 05/22/23 calls GLP-1 use for weight loss alone a non-covered benefit.Individual (ACA) plans:There will continue to be a high number of requests for many of these products, often used for weight loss alone, which is a non-covered benefit.ambetterhealth.com, Sep 29, 2026

For Wegovy’s heart-failure (HFpEF) indication, Ambetter’s policy (TX page, effective 2026-03-01) requires documented participation in a physician-directed weight loss program with diet, activity and behavior change.Individual (ACA) plans:Documentation support’s member’s participation in a physician-directed weight loss program that involves a reduced calorie diet, increased physical activity, and behavioral modification that meets both of the following:*ambetterhealth.com, Sep 29, 2026
One of those two requirements: at least 6 months of active enrollment in a physician-directed weight loss program.Individual (ACA) plans:Been actively enrolled in a physician-directed weight loss program for at least 6 months;ambetterhealth.com, Sep 29, 2026

Ambetter from Superior HealthPlan policy updates effective June 1, 2026 (Zepbound policy CP.PMN.298) mention obstructive sleep apnea continued-therapy criteria and a physician-directed weight loss program requirement.Individual (ACA) plans:Modified preferred liraglutide product to state ‘liraglutide (generic Victoza);’ for obstructive sleep apnea continued therapy, clarified “physician directed” weight loss programambetterhealth.com, Sep 29, 2026

Ambetter’s Wegovy policy update effective March 1, 2026 revised the cardiovascular event prevention criteria for members with concurrent type 2 diabetes.Individual (ACA) plans:For cardiovascular event prevention, revised language for members with concurrent type 2 diabetes mellitus language from "failure" to "member has received optimal diabetic standard of care therapy as evidenced by a trial" to align with verbiage in metabolic dysfunction-associated steatohepatitis criterionambetterhealth.com, Sep 29, 2026

Ambetter’s GLP-1 receptor agonist policy (HIM.PA.53) update effective March 1, 2026 added pre-emptive criteria for Rybelsus and Ozempic in diabetic patients with CVD or symptomatic PAD.Individual (ACA) plans:Added pre-emptive criteria for Rybelsus (diabetic patients with established cardiovascular disease) and Ozempic (diabetic patients with symptomatic PAD)ambetterhealth.com, Sep 29, 2026
HIM.PA.53 update effective June 1, 2026 renamed “Rybelsus formulation R2” to “Ozempic tablets”.Individual (ACA) plans:Revised “Rybelsus formulation R2” to “Ozempic tablets” per manufacturer rebranding and clarified Ozempic tablets vs injection where applicableambetterhealth.com, Sep 29, 2026

Effective March 1, 2026, Ambetter’s Wegovy policy (CP.PMN.295) added Wegovy tablets.Individual (ACA) plans:Added new formulation Wegovy tablets to policyambetterhealth.com, Sep 29, 2026
Effective June 1, 2026, the Zepbound policy (CP.PMN.298) added the multi-dose vial and KwikPen dosage forms.Individual (ACA) plans:Added new multi-dose vial dosage form and new kwikpen dosage formambetterhealth.com, Sep 29, 2026
The June 1, 2026 policy changes apply to Superior HealthPlan, Ambetter from Superior HealthPlan and Ambetter Health Solutions (ICHRA).Individual (ACA) plans:Superior HealthPlan, Ambetter from Superior HealthPlan and Ambetter Health Solutions (ICHRA) has added, updated, or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided.ambetterhealth.com, Sep 29, 2026

Ambetter (Texas) points members to its Formulary/Prescription Drug List for covered drugs.Individual (ACA) plans:Use our Formulary/Prescription Drug List to find more information on the drugs that Ambetter Health covers.ambetterhealth.com, Sep 29, 2026
If a drug is not on the formulary, the provider can request a non-formulary exception like a prior authorization.Individual (ACA) plans:If your drug is not covered by our formulary, your provider can request a non-formulary exception request. Your provider can submit the non-formulary exception the same way as a regular prior authorization.ambetterhealth.com, Sep 29, 2026
Ambetter Arkansas tells members with questions about GLP-1 coverage to call 1-877-617-0390.Individual (ACA) plans:Thank you for trusting Ambetter in your healthcare journey. If you have any questions or concerns, please contact us at 1-877-617-0390 (TTY: 1-877-617-0392).ambetterhealth.com, Sep 29, 2026

No web page from Ambetter that we could read covers: does it depend on your employer or plan.
More detail, such as exact BMI cutoffs, is in 4 PDF documents from Ambetter, which we have not opened.