Does Medicaid cover GLP-1s for weight loss?
It is up to each state. In their own pages and documents, 8 states say they cover them, 2 cover them only in narrow cases, and 38 say they do not. For the other 3, we have not found the state's own answer (some of their pages block automated reading), so we have not confirmed it.
CMS proposed rule in the Federal Register (Dec 10, 2024): weight-loss drugs have historically been an optional Medicaid benefit, at each state Medicaid program’s discretion. federalregister.gov
Last updated Sep 30, 2026; each line shows the day we read it. Adults, weight loss only; sleep apnea, heart and diabetes uses are listed separately under each state. Your Medicaid plan or pharmacist can confirm your own coverage.
All states
| State | What its own pages and documents say |
|---|---|
| Alabama | Does not cover them for weight loss Based on the drug list reference tool effective October 1, 2026; the April 1, 2026 version says the same about Wegovy. |
| Alaska | Does not cover them for weight loss Based on the state regulation, not a Medicaid agency page. |
| Arizona | Does not cover them for weight loss |
| Arkansas | Does not cover them for weight loss |
| California | Does not cover them for weight loss |
| Colorado | Does not cover them for weight loss |
| Connecticut | Does not cover them for weight loss |
| Delaware | Covers GLP-1s for weight loss |
| District of Columbia | Does not cover them for weight loss Based on a Zepbound prior authorization form revised July 3, 2025. |
| Florida | Does not cover them for weight loss Based on the state plan's list of excluded drug classes (amendment 2022-0002). A drug-limits summary dated Aug 31, 2026 still lists Saxenda with a minimum age of 12 and does not say whether it is covered. |
| Georgia | Does not cover them for weight loss Based on the state plan amendment effective Jan 1, 2024, which excludes weight-loss drugs. The only drug-specific document we read is a 2021 prior authorization summary about Saxenda. |
| Hawaii | Does not cover them for weight loss Based on findings in a 2026 bill that did not pass, which say “in most situations”. Med-QUEST's own pages (read in a browser on Sep 28, 2026) do not say. Treat as unconfirmed. |
| Idaho | Not confirmed in the state's own pages |
| Illinois | Does not cover them for weight loss |
| Indiana | Does not cover them for weight loss |
| Iowa | Does not cover them for weight loss |
| Kansas | Covers GLP-1s for weight loss The criteria document was last revised in August 2024, with minor updates on June 1, 2025; the drug list is dated August 1, 2026. |
| Kentucky | Does not cover them for weight loss |
| Louisiana | Does not cover them for weight loss |
| Maine | Does not cover them for weight loss |
| Maryland | Does not cover them for weight loss |
| Massachusetts | Not confirmed in the state's own pages |
| Michigan | Covers them only in narrow cases Based on the state budget law. |
| Minnesota | Covers GLP-1s for weight loss The criteria come from the Minnesota DHS page, which blocks automated reading; we read it in a browser on Sep 28, 2026. |
| Mississippi | Covers GLP-1s for weight loss |
| Missouri | Covers GLP-1s for weight loss Based on an October 2025 provider newsletter. A newer drug-list rule took effect in April 2026; its terms are in a Word file. |
| Montana | Does not cover them for weight loss |
| Nebraska | Does not cover them for weight loss The state page we read is not dated. |
| Nevada | Does not cover them for weight loss Based on the Medicaid Services Manual chapter 1200 effective Aug 31, 2026. Wegovy (heart risk, MASH) and Zepbound (sleep apnea) are covered for those uses with prior authorization. |
| New Hampshire | Does not cover them for weight loss |
| New Jersey | Does not cover them for weight loss Based on a 2025 memo; we found no 2026 state page, and a 2026 bill to require coverage has not passed. |
| New Mexico | Does not cover them for weight loss |
| New York | Does not cover them for weight loss |
| North Carolina | Covers GLP-1s for weight loss |
| North Dakota | Does not cover them for weight loss Based on a December 2023 provider newsletter; no later newsletter says otherwise. |
| Ohio | Does not cover them for weight loss |
| Oklahoma | Does not cover them for weight loss |
| Oregon | Does not cover them for weight loss |
| Pennsylvania | Does not cover them for weight loss |
| Rhode Island | Does not cover them for weight loss Coverage for weight loss ends October 1, 2026, under the enacted state budget, per the agency's pharmacy page; we read it in a browser because the site blocks automated reading. |
| South Carolina | Does not cover them for weight loss Based on an actuarial report Milliman wrote for the state (June 19, 2026), not a notice from the Medicaid agency. |
| South Dakota | Does not cover them for weight loss Based on the drug list on Optum Rx's site, which the state links to, not a state page. |
| Tennessee | Covers GLP-1s for weight loss Based on interim criteria from August 2025; later updates are published as PDFs. |
| Texas | Not confirmed in the state's own pages |
| Utah | Does not cover them for weight loss Based on a prior authorization form last updated June 1, 2026, which says weight-loss coverage is a pilot that may not continue past June 30, 2026 and only renews earlier approvals until then. |
| Vermont | Does not cover them for weight loss |
| Virginia | Covers them only in narrow cases Based on a June 2023 bulletin, the latest criteria on a web page; later changes are in PDFs and budget text. |
| Washington | Does not cover them for weight loss |
| West Virginia | Does not cover them for weight loss Based on the Zepbound criteria effective July 1, 2025, which say weight-loss drugs are “typically” not covered. |
| Wisconsin | Covers GLP-1s for weight loss From the drug list effective October 1, 2026; the prior authorization criteria come from the ForwardHealth handbook. |
| Wyoming | Does not cover them for weight loss Based on a clinical criteria chart (June 8, 2026) that allows Wegovy only with heart disease and Zepbound only with sleep apnea; it does not say in words that weight loss is excluded. |
State by state
AlabamaDoes not cover them for weight loss
Program: Alabama Medicaid Agency. medicaid.alabama.gov
Based on the drug list reference tool effective October 1, 2026; the April 1, 2026 version says the same about Wegovy.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Alabama Medicaid’s preferred drug list reference tool effective October 1, 2026 (a PDF): Wegovy is available with prior authorization (PA) for its heart (cardiovascular) and MASH liver indications, and is not covered for weight reduction.
Wegovy is available via PA for its cardiovascular and metabolic dysfunction-associated steatohepatitis (MASH) indications. Wegovy is non-covered for weight reduction.
medicaid.alabama.gov, Sep 29, 2026 - Same document: Zepbound is preferred with clinical criteria for obstructive sleep apnea (OSA) with obesity, and is not covered for weight reduction without OSA.
Zepbound is preferred with clinical criteria for its Obstructive Sleep Apnea (OSA) with obesity indication. Zepbound is non-covered for weight reduction without OSA.
medicaid.alabama.gov, Sep 29, 2026 Effective 10/01/2026
medicaid.alabama.gov, Sep 29, 2026- The earlier reference tool, effective April 1, 2026 (a PDF), has the same Wegovy note: PA for the heart and MASH indications, not covered for weight reduction.
Wegovy is available via PA for its cardiovascular and metabolic dysfunction-associated steatohepatitis (MASH) indications. Wegovy is non-covered for weight reduction.
medicaid.alabama.gov, Sep 29, 2026 Effective 04/01/2026
medicaid.alabama.gov, Sep 29, 2026- Alabama Administrative Code rule 560-X-16-.01 (Alabama Medicaid pharmacy rule) excludes drugs used for weight loss, except those the Alabama Medicaid Agency specifies; covered drugs are listed on the state’s website.
(b) Agents when used for anorexia, weight loss, or weight gain except for those specified by the Alabama Medicaid Agency. Selective covered outpatient drugs for all eligible beneficiaries will be covered as listed on the state's website.
admincode.legislature.state.al.us, Sep 30, 2026 Amended: Published January 31, 2024; effective March 16, 2024.
admincode.legislature.state.al.us, Sep 30, 2026
Changes
- Alabama Medicaid ALERT dated 6/22/2026 lists changes effective July 1, 2026.
Effective July 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
medicaid.alabama.gov, Sep 30, 2026 - Effective July 1, 2026, Wegovy was added to the Alabama PDL (Incretin Mimetics) as preferred with clinical criteria (“CC”); the ALERT does not say for which indication.
Update the PDL to reflect the quarterly updates listed below: PDL Additions StarjemzaCC TIMs/Biologics/DMARDs WegovyCC Incretin Mimetics
medicaid.alabama.gov, Sep 30, 2026 - Legend on the same ALERT: “CC” = preferred with clinical criteria.
CC This agent will be preferred with clinical criteria in place.
medicaid.alabama.gov, Sep 30, 2026 - Alabama Medicaid ALERT dated 9/18/2026 lists changes effective October 1, 2026.
Effective October 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
medicaid.alabama.gov, Sep 30, 2026 - Effective October 1, 2026, Wegovy is listed among PDL deletions (Incretin Mimetics), i.e. no longer preferred; the ALERT does not state whether/how it remains covered.
PDL Deletions ciprofloxacin-hydrocortisone (generic Cipro HC) EENT Antibacterials Farxiga Sodium-glucose Co-transporter 2 Inhibitors Fiasp Insulins fluticasone furoate (generic Arnuity Ellipta) Respiratory Agents – Adrenals insulin glargine max solostar (generic Toujeo Max Solostar) Insulins insulin glargine solostar (generic Toujeo Solostar) Insulins tobramycin-loteprednol (generic Zylet) EENT Antibacterials umeclidinium ellipta (generic Incruse Ellipta) Inhaled Antimuscarinics Wegovy Incretin Mimetics
medicaid.alabama.gov, Sep 30, 2026
Type 2 diabetes
- Alabama Medicaid ALERT dated 12/8/2025: changes effective January 1, 2026.
Effective January 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
medicaid.alabama.gov, Sep 30, 2026 - Effective January 1, 2026, Mounjaro was added to the PDL (Incretin Mimetics) as preferred with clinical criteria (“CC”); Bydureon Bcise was deleted. Ozempic status is not stated on this web page.
fluticasone/salmeterol (generic AirDuo Respiclick) Respiratory Corticosteroids Mounjaro CC Incretin Mimetics
medicaid.alabama.gov, Sep 30, 2026 - Legend on the same ALERT: “CC” = preferred with clinical criteria.
CC This agent will be preferred with clinical criteria in place.
medicaid.alabama.gov, Sep 30, 2026
10 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
AlaskaDoes not cover them for weight loss
Program: Alaska Department of Health administers Alaska Medical Assistance. health.alaska.gov
Based on the state regulation, not a Medicaid agency page.
Weight loss
- Alaska Medicaid regulation 7 AAC 120.112 (Non-covered drugs) says the department will not pay for a drug used to treat obesity. Source: Alaska Administrative Code as published by the Alaska Legislature (akleg.gov).
Notwithstanding 7 AAC 120.110, the department will not pay for (1) a drug used to treat infertility, obesity, or baldness;
akleg.gov, Sep 30, 2026
4 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
ArizonaDoes not cover them for weight loss
Program: AHCCCS is Arizona's Medicaid agency. azahcccs.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- AHCCCS (Arizona Medicaid) pharmacy prior authorization guidelines (a PDF in AHCCCS’s 2026 pharmacy updates, file named as effective 09/01/26), Wegovy guideline (effective date 2/1/2026): Wegovy used to treat weight loss is excluded and is denied as a benefit exclusion.
Wegovy when used for the treatment of weight loss is excluded and is to be denied as a benefit exclusion
azahcccs.gov, Sep 29, 2026 Guideline Note: Effective Date: 2/1/2026
azahcccs.gov, Sep 29, 2026- A note repeated in several guidelines of the same file: medications used for anti-obesity or weight-loss purposes are not medically accepted indications and are not recognized as a covered benefit.
Medications used for anti-obesity/weight loss, cosmetic (e.g., alopecia, actinic keratosis, vitiligo), erectile dysfunction, and sexual dysfunction purposes are NOT medically accepted indications and are NOT recognized as a covered benefit.
azahcccs.gov, Sep 29, 2026 - GLP-1 agonist guideline in the same file: if the drug is requested for appetite suppression or weight loss, or to improve conditions caused by obesity (the example given is Zepbound for sleep apnea), the request is denied as a plan exclusion.
If requested medication is being used to treat appetite suppression/weight loss or improve conditions caused by obesity (i.e., Zepbound for OSA) – deny the case for Plan Exclusion.
azahcccs.gov, Sep 29, 2026
Changes
- Arizona Senate fact sheet for SB 1621 (2026; legislature text): Laws 2025, Chapter 218 set up an Obesity Treatment Study Committee to study the cost and value of expanding AHCCCS (Medicaid) coverage to comprehensive obesity treatment. It does not say what AHCCCS covers today.
Laws 2025, Chapter 218 established the Obesity Treatment Study Committee (Study Committee) to study the cost, potential savings, effectiveness, health outcomes and value of expanding coverage under the Arizona Health Care Cost Containment System (AHCCCS) to include comprehensive treatment for people living with obesity.
azleg.gov, Sep 30, 2026 - SB 1621 (2026 bill) would create an Obesity Treatment and Prevention Advisory Council; it does not change drug coverage. Whether it passed was not checked.
Establishes the Obesity Treatment and Prevention Advisory Council (Advisory Council) to assess the potential cost savings of providing Medicaid coverage for preventive care, evaluating and recommending public policy and funding strategies and identifying health care system gaps.
azleg.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy has a separate approval path when treatment is requested to reduce the risk of major adverse cardiovascular events.
Treatment is being requested to reduce the risk of major adverse cardiovascular events
azahcccs.gov, Sep 29, 2026 - For that path the patient must be 45 or older and have medical records showing a BMI of 30 or more.
2 - Patient is 45 years of age or older AND 3 - Submission of medical records (e.g., chart notes) documenting all the following: 3.1 BMI (body mass index) greater than or equal to 30 kg/m2 (kilograms per square meter)
azahcccs.gov, Sep 29, 2026
Type 2 diabetes
- GLP-1 Agonists guideline (effective June 1, 2026): the preferred drugs are Trulicity, brand Victoza, generic liraglutide and exenatide.
Product Name:Preferred Drugs: Trulicity, Brand Victoza, generic liraglutide, Exenatide
azahcccs.gov, Sep 29, 2026 - Mounjaro and Ozempic injection are non-preferred in the same guideline.
Product Name:Non-Preferred Drugs: Mounjaro, Ozempic injection
azahcccs.gov, Sep 29, 2026
8 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
ArkansasDoes not cover them for weight loss
Program: Arkansas DHS Division of Medical Services runs Arkansas Medicaid. humanservices.arkansas.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Arkansas Medicaid provider memo dated May 13, 2026 (a PDF): adding Wegovy tablets under the heart-risk (MACE) criteria, it says the Arkansas Medicaid Pharmacy Program does not cover medications for weight loss.
NOTE: Wegovy tablets have been added to the Wegovy injection page in the PA criteria document concerning the MACE indication. The tablets will follow the same criteria as the injection. The Arkansas Medicaid Pharmacy Program does not cover medications for weight loss.
humanservices.arkansas.gov, Sep 29, 2026 DATE: May 13, 2026
humanservices.arkansas.gov, Sep 29, 2026- Arkansas Medicaid clinical prior authorization criteria (revised July 1, 2026, a PDF), Wegovy page: Arkansas Medicaid does not currently cover medications solely for weight loss; Wegovy requests must show established heart disease and a risk of a major cardiovascular event.
Note: Arkansas Medicaid does not currently cover medications solely for the use of weight loss. PA requests for this medication must demonstrate that the beneficiary has established cardiovascular disease and is at risk for a major cardiovascular event.
ar.primetherapeutics.com, Sep 29, 2026 - Same document, Zepbound page: Arkansas Medicaid does not cover medications solely for weight loss; the Zepbound criteria are for obstructive sleep apnea only.
Arkansas Medicaid does not cover medications solely for weight loss. The criteria listed below pertain to the obstructive sleep apnea indication only.
ar.primetherapeutics.com, Sep 29, 2026 Arkansas Medicaid Clinical Criteria Revised: July 1, 2026
ar.primetherapeutics.com, Sep 29, 2026
Changes
- 2025 legislation: HB1424 (“to mandate coverage for severe obesity treatments”) became Act 628 of 2025 (Arkansas Legislature bill page). Whether it covers weight-loss drugs is only in the Act PDF.
HB1424 - TO MANDATE COVERAGE FOR SEVERE OBESITY TREATMENTS.
arkleg.state.ar.us, Sep 30, 2026 - HB1424 status on the Arkansas Legislature site.
Notification that HB1424 is now Act 628
arkleg.state.ar.us, Sep 30, 2026 - 2025 bill HB1332 (Medicaid obesity-related bill) did not pass: died in Senate committee.
Senate -- Died in Senate Committee at Sine Die adjournment.
arkleg.state.ar.us, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy for heart risk (MACE, injection and tablet): the member must be diagnosed with established cardiovascular disease (the criteria list which kinds).
Diagnosed with established cardiovascular disease with at least one of the following:
ar.primetherapeutics.com, Sep 29, 2026 - The same Wegovy criteria need a baseline BMI of 27 or more.
Considered either obese or overweight (defined as baseline BMI of ≥ 27 kg/m2)
ar.primetherapeutics.com, Sep 29, 2026 - Wegovy for MASH: the request should not be for weight loss only.
Prior authorization request should not be for weight loss only
ar.primetherapeutics.com, Sep 29, 2026 - Zepbound for sleep apnea: moderate to severe obstructive sleep apnea with an apnea-hypopnea index (AHI) of 15 or more on a sleep study (polysomnography).
The beneficiary must be diagnosed with moderate to severe obstructive sleep apnea (OSA) defined as apnea-hypopnea index (AHI) ≥ 15 respiratory events per hour based on polysomnography (PSG) results.
ar.primetherapeutics.com, Sep 29, 2026 - Zepbound for sleep apnea also needs a BMI of 30 or more and at least one weight-related condition.
The beneficiary must have a baseline diagnosis of obesity defined as body mass index (BMI) ≥ 30 kg/m2 and at least one of the following weight-related comorbid conditions:
ar.primetherapeutics.com, Sep 29, 2026
11 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
CaliforniaDoes not cover them for weight loss
Program: Medi-Cal is administered by the California Department of Health Care Services. lao.ca.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- Medi-Cal Rx member notice (changes effective January 1, 2026): Wegovy for weight loss only is no longer covered, and earlier approvals ended December 31, 2025.
If you take Wegovy for weight loss only, it is no longer covered. Previously approved requests from your pharmacy provider or prescriber, called prior authorizations (PAs), ended on December 31, 2025.
medi-calrx.dhcs.ca.gov, Sep 28, 2026 - The same notice says the same for Zepbound and Saxenda.
If you take one of these drugs for weight loss only, it is no longer covered. Previously approved PAs from your pharmacy provider or prescriber ended on December 31, 2025.
medi-calrx.dhcs.ca.gov, Sep 28, 2026 - California Legislative Analyst’s Office (state legislature, lao.ca.gov; not DHCS itself) reports the Legislature ended Medi-Cal coverage for drugs used to treat obesity (report dated March 2026).
The Legislature also ended coverage for certain drugs, with most savings resulting from the end of coverage for drugs used to treat obesity.
lao.ca.gov, Sep 30, 2026
Changes
- 2025-26 budget: Medi-Cal coverage of GLP-1s used to treat obesity (e.g. Wegovy) ends beginning January 2026 (LAO summary of the enacted spending plan).
The spending plan ends coverage of certain optional pharmacy benefits in Medi-Cal, beginning January 2026. Most notably, the administration plans to end coverage of Glucagon-Like Peptide-1 (GLP-1) agonists used to treat obesity (such as Wegovy).
lao.ca.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- For Zepbound used for obstructive sleep apnea, Medi-Cal Rx says to ask about a prior authorization request.
Talk to your pharmacy provider or prescriber about submitting a PA request if you take Zepbound for obstructive sleep apnea (OSA).
medi-calrx.dhcs.ca.gov, Sep 28, 2026
Type 2 diabetes
- Medi-Cal continues to cover GLP-1s for diabetes such as Ozempic (LAO).
(Medi-Cal will still cover GLP-1s that treat diabetes, such as Ozempic, as required under federal law.)
lao.ca.gov, Sep 30, 2026
What Medicaid health plans in California say
- Blue Shield Promise’s Medi-Cal page says the state Department of Health Care Services (DHCS) manages the member’s pharmacy benefit through the state-run Medi-Cal Rx program.Blue Shield of California:
The Department of Health Care Services (DHCS) manages your pharmacy benefit through the state-run program called Medi-Cal Rx.
blueshieldca.com, Sep 30, 2026
6 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
ColoradoDoes not cover them for weight loss
Program: Colorado Department of Health Care Policy and Financing. hcpf.colorado.gov
Weight loss
- Health First Colorado (Colorado Medicaid) lists weight-loss drugs among the medication categories it does not cover for any reason.
Health First Colorado does not cover the following categories of medications for any reason: Non-Rebatable Drugs Fertility Drugs Drug Efficacy Study Implementation (DESI) Drugs Cosmetic Drugs Weight-Loss Drugs
hcpf.colorado.gov, Sep 30, 2026 - The HCPF Pharmacy Billing Manual restricted-products table gives the category "Anorexia (weight loss)" a benefit level of "None".
Anorexia (weight loss) None
hcpf.colorado.gov, Sep 30, 2026 - In that table, "None" means no products in the category are program benefits.
None No products in the category are Medical Assistance Program benefits.
hcpf.colorado.gov, Sep 30, 2026
4 more documents are PDFs, which we have not opened.
ConnecticutDoes not cover them for weight loss
Program: HUSKY Health. portal.ct.gov
Weight loss
- The HUSKY Health (CT Medicaid/CHIP) member pharmacy page lists "Drugs to treat obesity" among drug types the Pharmacy Benefit does not cover. (Page is undated; a June 2025 bulletin title says DSS began covering the non-GLP-1 weight-loss drugs phentermine and orlistat, so the page may lag on those two, but no official web shows GLP-1 coverage for weight loss.)
The Pharmacy Benefit does not cover the following types of drugs. Drugs to treat sexual problems Drugs to treat cosmetic conditions Drugs to treat obesity
portal.ct.gov, Sep 30, 2026 - HUSKY provider bulletin 2025-31 (June 20, 2025) title: GLP-1 medications got an updated diagnosis requirement, and the only new weight-loss drug coverage announced was phentermine and orlistat (not GLP-1s).
2025.31 - Provider Bulletin - Updated Diagnosis Requirement for GLP-1 Agonist Medications and New Coverage of FDA Approved Weight Loss Drug Phentermine and Orlistat (June 20, 2025)
huskyhealthct.org, Sep 30, 2026
Criteria
- CT statute 17b-278l as amended in 2025: the obesity "medical services" Medicaid may cover are obesity drugs for people with type 2 diabetes and drugs for a comorbid condition in people with obesity, subject to prior authorization and step therapy.
prescription drugs approved by the federal Food and Drug Administration for the treatment of obesity on an outpatient basis for individuals with type 2 diabetes and prescription drugs approved by the federal Food and Drug Administration on an outpatient basis for the treatment of a comorbid condition for individuals with obesity, subject to prior authorization and only after step therapy when clinically appropriate
cga.ct.gov, Sep 30, 2026 - The amended statute makes this coverage optional and only for beneficiaries with BMI over 35, and only after an approved state plan amendment.
to provide for this optional coverage under such programs, in accordance with federal law, for (1) bariatric surgery and related medical services for Medicaid and HUSKY B beneficiaries with severe obesity, and (2) medical services for Medicaid and HUSKY B beneficiaries with a body mass index greater than thirty-five
cga.ct.gov, Sep 30, 2026 - Coverage under 17b-278l starts only once a state plan amendment is approved.
Upon approval of any state plan amendment, the Department of Social Services shall provide said coverage.
cga.ct.gov, Sep 30, 2026
Changes
- Dec 6, 2024: DSS issued a bulletin adding a diagnosis requirement for GLP-1 agonist medications (details in PDF bulletin 2024-66).
2024.66 - Provider Bulletin - Diagnosis Requirement for GLP-1 Agonist Medications (December 6, 2024)
huskyhealthct.org, Sep 30, 2026 - May 19, 2025: Governor Lamont proposed repealing GLP-1 coverage for weight loss only, to contain Medicaid costs.
To contain costs, Governor Lamont has proposed repealing the GLP-1s for weight loss only.
portal.ct.gov, Sep 30, 2026 - Before the 2025 amendment (statutes revised to Jan 1, 2025), 17b-278l said DSS "shall provide" obesity medical services, defined to include FDA-approved obesity drugs, for beneficiaries with BMI over 35.
(b) The Commissioner of Social Services shall provide medical assistance for (1) bariatric surgery and related medical services for Medicaid and HUSKY B beneficiaries with severe obesity, and (2) medical services for Medicaid and HUSKY B beneficiaries with a body mass index greater than thirty-five
cga.ct.gov, Sep 30, 2026 - P.A. 25-168 (effective July 1, 2025) deleted the mandatory coverage requirement and made the coverage optional, subject to an approved state plan amendment, and added step-therapy limits.
amended Subsec. (b) by deleting mandatory coverage requirement, deleting provision re commissioner authority to amend state plans and replacing it with language authorizing such amendments, inserting provision describing such coverage as optional and requiring state plan amendments be approved before coverage begins and added Subsecs. (c) and (d) re step therapy requirements, effective July 1, 2025.
cga.ct.gov, Sep 30, 2026 - The same 2025 law requires DSS to report yearly on Medicaid GLP-1 use and cost, starting January 15, 2026.
The Commissioner of Social Services shall collect data concerning the use by Medicaid beneficiaries of glucagon-like peptide (GLP-1) drugs and costs and benefits to the state. Not later than January 15, 2026, and annually thereafter
cga.ct.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Bulletin 2025-32 (June 27, 2025): Zepbound covered for obstructive sleep apnea (per bulletin title; criteria are in the PDF).
2025.32 - Provider Bulletin - Zepbound for Treatment of Obstructive Sleep Apnea (June 27, 2025)
huskyhealthct.org, Sep 30, 2026 - Bulletin 2025-04 (Jan 17, 2025): Wegovy covered to reduce the risk of major adverse cardiac events (per bulletin title).
2025.04 - Wegovy Coverage for Risk Reduction of Major Adverse Cardiac Event (January 17, 2025)
huskyhealthct.org, Sep 30, 2026 - Bulletin 2025-54 (Oct 10, 2025): Wegovy coverage for MASH and MACE (per bulletin title).
2025.54 - Wegovy Coverage for MASH & MACE (October 10, 2025)
huskyhealthct.org, Sep 30, 2026 - The CT pharmacy page links PA forms for Wegovy (MACE risk reduction), Wegovy (MASH) and Zepbound (OSA).
Wegovy for MACE Risk Reduction Prior Authorization Form Wegovy for MASH Prior Authorization Form Zepbound for Treatment of Obstructive Sleep Apnea Prior Authorization Form
ctdssmap.com, Sep 30, 2026
Type 2 diabetes
- The CT Medical Assistance Program pharmacy page has a list of clinical prior authorization criteria for non-preferred drugs that took effect 1/1/2026.
Clinical Prior Authorization for Non-Preferred Drugs (new effective 1/1/2026)
ctdssmap.com, Sep 30, 2026 - That 1/1/2026 list includes a "GLP-1/GIP Agonists (Diabetes)" class, so non-preferred GLP-1 diabetes drugs need clinical PA. The criteria themselves are in a PDF. (The quote keeps the page’s non-breaking hyphen, U+2011.)
GLP‑1/GIP Agonists (Diabetes)
ctdssmap.com, Sep 30, 2026 - The same page links a clinical PA form for the incretin mimetic class of hypoglycemics (the GLP-1 diabetes drugs).
Hypoglycemics Incretin Mimetics Enhancers Clinical PA Form
ctdssmap.com, Sep 30, 2026
10 more documents are PDFs, which we have not opened.
DelawareCovers GLP-1s for weight loss
Program: Delaware Division of Medicaid and Medical Assistance. dhss.delaware.gov
Weight loss
- Delaware Medicaid State Plan (final order effective Dec 11, 2019): drugs indicated for the treatment of obesity are covered, with co-morbid conditions and prior authorization. (Brand-level list, e.g. Wegovy/Zepbound, is only in the PDF PDL.)
Drugs indicated for the treatment of obesity to address weight loss with co-morbid conditions are covered by the DMAP with prior authorization.
regulations.delaware.gov, Sep 30, 2026 - Sept 2026 final order on the "GLP-1" State Plan amendment: the change only aligns the plan text with current coverage practice and does not change which drugs are covered or the criteria.
It aligns the State Plan language with current coverage practice and is not intended to change which medications/agents/drugs are covered or the criteria for coverage.
regulations.delaware.gov, Sep 30, 2026 - Under the amended plan, covered weight-loss agents are those listed on the state website.
The proposed change removes specific language about state coverage of weight loss drugs and replaces it with more general language that indicates that select agents for anorexia, weight loss, and weight gain will be covered as listed on the state's website.
regulations.delaware.gov, Sep 30, 2026
Criteria
- State Plan text: obesity drugs are covered to address weight loss with co-morbid conditions, with prior authorization (BMI thresholds are only in the PDF PA form).
3) The State will cover drugs indicated for the treatment of obesity to address weight loss with co- morbid conditions with prior authorization.
regulations.delaware.gov, Sep 30, 2026 - Weight-loss drugs used only for cosmetic reasons stay excluded.
d. Drugs when used for anorexia, weight loss or weight gain, or weight loss for the sole purpose of cosmetic reasons.
regulations.delaware.gov, Sep 30, 2026
Changes
- The 2019 obesity-drug State Plan change was adopted effective December 11, 2019.
is adopted and shall be final effective December 11, 2019.
regulations.delaware.gov, Sep 30, 2026 - July 2026 proposal: DMMA proposed a State Plan amendment on GLP-1 to give the state flexibility on weight-loss drug coverage (comments due July 31, 2026).
is proposing to amend the Title XIX Medicaid State Plan regarding Glucagon-Like Peptide-1 (GLP-1), specifically, to broaden the language in the State Plan with guidance from CMS, to provide the state with increased flexibility to determine coverage of drugs for anorexia, weight loss, and weight gain without additional changes to the State Plan.
regulations.delaware.gov, Sep 30, 2026 - The GLP-1 State Plan amendment has a stated effective date of January 1, 2026.
Effective January 1, 2026, the DHSS/DMMA proposes to amend Title XIX Medicaid State Plan to clarify criteria for GLP-1.
regulations.delaware.gov, Sep 30, 2026 - Final order (signed 8/14/2026, Sept 2026 Register): the GLP-1 amendment was adopted, effective ten days after publication.
is adopted and shall be final effective ten days after publication in the Register.
regulations.delaware.gov, Sep 30, 2026 - The amendment was framed as enabling participation in federal and manufacturer models for better access and pricing.
including participation in federal and manufacturer models designed to improve access and improve pricing, without the need to make additional changes to the State Plan.
regulations.delaware.gov, Sep 30, 2026
6 more documents are PDFs, which we have not opened. 4 of the state's pages blocked automated reading.
District of ColumbiaDoes not cover them for weight loss
Program: DC Department of Health Care Finance. dhcf.dc.gov
Based on a Zepbound prior authorization form revised July 3, 2025.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- DC Department of Health Care Finance’s Zepbound prior authorization form (a PDF linked from the DC pharmacy benefit manager’s forms page; revision date 07/03/2025): anti-obesity drugs are excluded from coverage in the District DHCF Pharmacy Program.
Note: Anti-obesity drugs are excluded from coverage for the District DHCF Pharmacy Program.
dc-pbm.com, Sep 29, 2026 Revision Date: 07/03/2025
dc-pbm.com, Sep 29, 2026
Sleep apnea, heart risk, MASH
- Zepbound is covered only for moderate to severe obstructive sleep apnea in adults (18 or older) with obesity (BMI of 30 or more) or overweight (BMI of 27 or more).
Zepbound is covered only for the indication below: • Moderate to severe obstructive sleep apnea and either obesity (body mass index [BMI] of ≥ 30 kg/m2) or overweight (BMI of ≥ 27 kg/m2) in adults (≥ 18 years old).
dc-pbm.com, Sep 29, 2026 - The same PBM portal lists a Wegovy PA request form (criteria only in the PDF).
Wegovy PA Request Form
dc-pbm.com, Sep 30, 2026 - It also lists a Zepbound PA request form (criteria only in the PDF).
Zepbound PA Request Form
dc-pbm.com, Sep 30, 2026
Type 2 diabetes
- DC’s fee-for-service pharmacy benefit manager portal (linked from DHCF) lists a GLP-1 PA request form; the criteria are only in the linked PDF.
GLP 1 PA Request Form
dc-pbm.com, Sep 30, 2026
9 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
FloridaDoes not cover them for weight loss
Program: Florida Agency for Health Care Administration. ahca.myflorida.com
Based on the state plan's list of excluded drug classes (amendment 2022-0002). A drug-limits summary dated Aug 31, 2026 still lists Saxenda with a minimum age of 12 and does not say whether it is covered.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 30, 2026. Our weekly check does not re-download files.
Weight loss
- Florida’s Medicaid state plan, Attachment 3.1-B (amendment 2022-0002): for agents used for anorexia, weight loss or weight gain, the box “None of the drugs under this drug class are covered” is checked.
(a) agents when used for anorexia, weight loss, weight gain ☒ None of the drugs under this drug class are covered
ahca.myflorida.com, Sep 30, 2026 The Medicaid agency provides coverage for the following excluded or otherwise restricted drugs or classes of drugs, or their medical uses to all Medicaid recipients, including full benefit dual eligible beneficiaries under the Medicare Prescription Drug Benefit –Part D.
ahca.myflorida.com, Sep 30, 2026- The same state plan page lists anorectics among the excluded drugs unless they are prescribed for an indication other than obesity.
Those excluded are DESI drugs; experimental drugs; anorectics (unless prescribed for an indication other than obesity);
ahca.myflorida.com, Sep 30, 2026 Amendment 2022-0002 Effective 1/1/2022 Supersedes 2014-002
ahca.myflorida.com, Sep 30, 2026
Criteria
- Florida’s managed care contract (MMA Exhibit II-A, update October 1, 2025) requires each plan to offer a medically directed weight loss program, which may include prescription drugs. It does not name any drug.
A medically directed weight loss program shall require ongoing supervision by a physician and may include the use of prescription drugs/supplements depending upon the need and goals of the enrollee, along with other physician approved interventions (e.g., diet or exercise).
ahca.myflorida.com, Sep 30, 2026 EXHIBIT II-A – UPDATE: OCTOBER 1, 2025
ahca.myflorida.com, Sep 30, 2026
Changes
- SB 648 (2025), which would have required Florida Medicaid to cover certain obesity treatments, died in committee; no enacted change was found.
requiring the agency to provide Medicaid coverage for certain treatments for obesity
flsenate.gov, Sep 30, 2026 - Status of SB 648: died in the Senate Health Policy committee (last action 6/16/2025).
Died in Health Policy
flsenate.gov, Sep 30, 2026
Type 2 diabetes
- AHCA posts GLP-1 receptor agonist PA criteria (updated 03/13/2026); the criteria text is only in the linked PDF.
Glucagon-like Peptide-1 (GLP-1) Receptor Agonist Criteria [ 232.2 kB ] Updated 03/13/2026
ahca.myflorida.com, Sep 30, 2026 - Florida Medicaid GLP-1 prior authorization criteria: Mounjaro, Ozempic and Trulicity are the preferred agents, each with clinical prior authorization.
Preferred agents (Clinical Prior Authorization Required): Mounjaro® (tirzepatide), Ozempic® (semaglutide), and Trulicity® (dulaglutide)
ahca.myflorida.com, Sep 30, 2026 - Same criteria: the patient must have type 2 diabetes, an HbA1c of 6.5% or higher in the past 6 months, and a trial of metformin in the past 2 years unless it cannot be used.
Patient must have a diagnosis of type 2 diabetes mellitus; AND Hemoglobin A1C (HbA1c) ≥ 6.5 % measured within the past 6 months (documentation required); AND Patient must have trial and failure of metformin within the past 2 years unless contraindicated or the patient is intolerant to treatment (documentation required)
ahca.myflorida.com, Sep 30, 2026 Revision Date: October 1, 2025, October 8, 2025, March 12, 2026
ahca.myflorida.com, Sep 30, 2026
2 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
GeorgiaDoes not cover them for weight loss
Program: Georgia Department of Community Health. medicaid.georgia.gov
Based on the state plan amendment effective Jan 1, 2024, which excludes weight-loss drugs. The only drug-specific document we read is a 2021 prior authorization summary about Saxenda.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026 and Sep 30, 2026. Our weekly check does not re-download files.
Weight loss
- Georgia’s Medicaid state plan, amendment GA-24-0001 (approved by CMS on June 6, 2024, effective January 1, 2024), lists agents used for anorexia, weight loss or weight gain among the drugs excluded from coverage.
As provided by Section 1927(d)(2) of the Act, certain outpatient drugs may be excluded from coverage. Those excluded are: Agents used for anorexia, weight loss or weight gain.
medicaid.georgia.gov, Sep 30, 2026 Approval Date June 6, 2024 Effective Date January 1, 2024
medicaid.georgia.gov, Sep 30, 2026- Georgia Medicaid fee-for-service PA summary “Antihyperlipidemics, Other”: Saxenda and Xenical are not covered for members 18 and older; members 12 to 17 need prior authorization.
Xenical and Saxenda are not covered for members younger than 12 years of age or for members 18 years of age and older and requires prior authorization for members 12 to 17 years of age.
dch.georgia.gov, Sep 30, 2026 Revised 07/09/2021
dch.georgia.gov, Sep 30, 2026
Criteria
- Georgia Medicaid/PeachCare preferred drug list effective September 1, 2026 (a PDF): Saxenda is listed as non-preferred with prior authorization marked “12 yrs-17 yrs”, under Antilipidemic Drugs. The list does not say whether adults can get it for weight loss.
SAXENDA NP PA (12 yrs-17 yrs)
dch.georgia.gov, Sep 29, 2026 Georgia Medicaid/PeachCare Preferred Drug List Effective September 1, 2026
dch.georgia.gov, Sep 29, 2026- The same list says it does not include every drug Georgia Medicaid covers.
This list does not include all drugs covered under the Georgia Medicaid/PeachCare for Kids outpatient pharmacy program.
dch.georgia.gov, Sep 29, 2026 - Same summary: Saxenda can be approved for members 12 to 17 who have high cholesterol (hypercholesterolemia or hyperlipidemia), take lipid-lowering drugs, weigh more than 60 kg and have a BMI of 30 or more.
Approvable for members 12 to 17 years of age with a diagnosis of hypercholesterolemia or hyperlipidemia who are currently taking lipid-lowering medications, who weigh greater than 60 kg and who have an initial body mass index (BMI) of 30 kg/m2 or greater
dch.georgia.gov, Sep 30, 2026
Type 2 diabetes
- Same list, Misc. Antidiabetic Agents: Mounjaro, Ozempic and Victoza are preferred (P) with prior authorization (PA) and quantity limits (QLL); Rybelsus, Soliqua and Trulicity are non-preferred (NP).
MOUNJARO P PA QLL OZEMPIC P PA QLL RYBELSUS NP PA QLL SOLIQUA NP PA QLL TRULICITY NP PA QLL VICTOZA P PA QLL
dch.georgia.gov, Sep 29, 2026 - Georgia Medicaid fee-for-service Antidiabetic Agents PA summary: Ozempic can be approved for members 18 and older with type 2 diabetes and an HbA1c of 6.5% or higher, to improve blood sugar control.
Approvable for members 18 years of age or older with a diagnosis of type 2 diabetes mellitus (T2DM) whose HbA1c level is 6.5% or higher when the requested medication is being used to improve glycemic control.
dch.georgia.gov, Sep 30, 2026 Revised 07/01/2026
dch.georgia.gov, Sep 30, 2026
3 of the state's pages blocked automated reading.
HawaiiDoes not cover them for weight loss
Program: Med-QUEST Division. medquest.hawaii.gov
Based on findings in a 2026 bill that did not pass, which say “in most situations”. Med-QUEST's own pages (read in a browser on Sep 28, 2026) do not say. Treat as unconfirmed.
Weight loss
- Hawaii Legislature (findings in 2026 bill HB2456 HD1, capitol.hawaii.gov) states that the Department of Human Services (Med-QUEST) has opted to exclude Saxenda, Wegovy and Zepbound for weight loss from Medicaid coverage “in most situations”. This is the legislature’s statement, not a Med-QUEST policy page; no Med-QUEST web page states a GLP-1 weight-loss policy.
although the United States Food and Drug Administration has approved the GLP‑1 drugs Saxenda (liraglutide), Wegovy (semaglutide), and Zepbound (tirzepatide) for purposes of weight loss, the department of human services has opted to exclude these medications from coverage under medicaid in most situations.
data.capitol.hawaii.gov, Sep 30, 2026
Criteria
- Legacy Med-QUEST fee-for-service PA criteria page (ICD-9 era, names Meridia/Xenical, does not name any GLP-1) lists PA criteria for appetite suppressants/anorexiants: weight and height or BMI plus the patient’s weight-loss program.
Appetite Suppressants/Anorexiants/Fat Absorption Decreasing Criteria: 1. Patient’s weight and height (or Body Mass Index) 2. Patient’s program for weight loss
medquest.hawaii.gov, Sep 30, 2026
Changes
- 2026 bill HB2456 HD1 would have made Medicaid recipients eligible for FDA-approved weight-loss GLP-1s when prescribed by a practitioner and the patient is in a lifestyle change program, with no prior authorization.
Any patient who is a medicaid prescription drug program recipient shall be eligible for coverage of glucagon-like peptide‑1 drugs as agents when used for weight loss; provided that: (1) The glucagon-like peptide‑1 drug is approved by the United States Food and Drug Administration for purposes of weight loss; (2) The glucagon-like peptide‑1 drug is prescribed by a practitioner; (3) The patient participates in a lifestyle change program that supports long-term weight loss maintenance; and (4) Prior authorization shall not be required.
data.capitol.hawaii.gov, Sep 30, 2026 - HB2456 HD1 proposed effective date (the bill was not enacted per the status page below).
This Act shall take effect on July 1, 2026.
data.capitol.hawaii.gov, Sep 30, 2026 - Bill status page: last recorded action on HB2456 is 2/18/2026 (passed House second reading as HD1, referred to Finance); no later action shown, i.e. not enacted per this page.
2/18/2026 H Passed Second Reading as amended in HD 1 and referred to the committee(s) on FIN
data.capitol.hawaii.gov, Sep 30, 2026
3 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
IdahoNot confirmed in the state's own pages
Program: Idaho Department of Health and Welfare runs the Idaho Medicaid Pharmacy Program. healthandwelfare.idaho.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 30, 2026. Our weekly check does not re-download files.
None of the state's web pages we could read say whether GLP-1s are covered for weight loss.
Criteria
- Idaho’s Medicaid Basic Plan rule (IDAPA 16.03.09, 2023 archive copy) covers services for non-surgical treatment of obesity only when they are an integral and necessary part of treating another medical condition that Medicaid covers. The rule does not name drugs.
Non-Surgical Treatment for Obesity. Services in connection with non-surgical treatment of obesity are covered only when such services are an integral and necessary part of treatment for another medical condition that is covered by Medicaid.
adminrules.idaho.gov, Sep 30, 2026 IAC Archive 2023
adminrules.idaho.gov, Sep 30, 2026
6 of the state's pages blocked automated reading.
IllinoisDoes not cover them for weight loss
Program: Illinois Department of Healthcare and Family Services. hfs.illinois.gov
Weight loss
- Illinois HFS provider notice (Sept 10, 2026; applies to FFS and managed care): Wegovy and Zepbound are not covered for weight loss alone.
At this time Wegovy and Zepbound will not be covered for weight loss alone.
hfs.illinois.gov, Sep 30, 2026 - Illinois administrative code 89 Ill. Adm. Code 140.441 (Pharmacy Services Not Covered) lists anorectic drugs among excluded items (does not name GLP-1s).
Anorectic drugs or combinations including such drugs;
ilga.gov, Sep 30, 2026
Changes
- Effective October 1, 2026, HFS adds coverage of Wegovy and Zepbound for specific FDA-approved non-weight-loss indications in adults (MACE, MASH, OSA).
Effective October 1, 2026, the Department will provide coverage for Wegovy and Zepbound when prescribed for the FDA approved indications in adults below:
hfs.illinois.gov, Sep 30, 2026 - The change applies to both fee-for-service and managed care.
These changes apply to both the Fee-For-Service (FFS) program and Managed Care program.
hfs.illinois.gov, Sep 30, 2026 - May 21, 2026 notice: Rybelsus discontinued; patients transition to Ozempic tablets (new prescription and new PA required).
Illinois Medicaid customers will not be automatically converted from Rybelsus to Ozempic tablets. A new prescription is required for any transition.
hfs.illinois.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- From Oct 1, 2026: Wegovy injection covered (with PA) to reduce MACE risk in adults with established CV disease and obesity or overweight.
To reduce the risk of major adverse cardiovascular events (MACE) (cardiovascular (CV) death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight.
hfs.illinois.gov, Sep 30, 2026 - From Oct 1, 2026: Wegovy injection covered (with PA) for noncirrhotic MASH with F2-F3 fibrosis in adults.
For the treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) in adults.
hfs.illinois.gov, Sep 30, 2026 - From Oct 1, 2026: Zepbound injection covered (with PA) for moderate to severe OSA in adults with obesity.
To treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.
hfs.illinois.gov, Sep 30, 2026 - Both drugs require prior authorization with diagnostic documentation of the qualifying condition.
Both medications will require prior authorization. Providers should submit: • A completed prior authorization request • Diagnostic documentation confirming the qualifying condition
hfs.illinois.gov, Sep 30, 2026
Type 2 diabetes
- Rybelsus (oral semaglutide) is preferred with PA on the Illinois Medicaid PDL for type 2 diabetes.
Rybelsus is currently preferred with prior authorization (PA) on the Illinois Medicaid Preferred Drug List (PDL) for patients with type 2 diabetes with or without high cardiovascular risk.
hfs.illinois.gov, Sep 30, 2026 - Ozempic tablets are also preferred with PA for type 2 diabetes; a new PA request is required.
Ozempic tablets will also be preferred with PA for the same indication. A new PA request will be required for Ozempic tablets.
hfs.illinois.gov, Sep 30, 2026 - No change to Ozempic injections (their PDL status is not stated on its web pages).
There are no changes to Ozempic injections.
hfs.illinois.gov, Sep 30, 2026 - HFS FFS formal criteria list includes a GLP-1 RA / GIP RA class criteria document dated 10-01-2026.
Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA) and Glucose-dependent Insulinotropic Polypeptide (GIP) Receptor Agonist DOC FFS 10-01-2026
ilpriorauth.com, Sep 30, 2026
What Medicaid health plans in Illinois say
- Molina Healthcare of Illinois (Medicaid) member drug page: some drugs are never covered by the plan.Molina Healthcare:
Some drugs are never covered by your plan. For example:
molinahealthcare.com, Sep 30, 2026 - Drugs for weight loss are on that never-covered list, unless other rules apply.Molina Healthcare:
Drugs for weight loss (unless other rules apply).
molinahealthcare.com, Sep 30, 2026 - Molina Illinois Medicaid offers a preferred drug list search tool (lead-in to a list: search by name/class, find generics, see limits and PA).Molina Healthcare:
Use our preferred drug list search tool to:
molinahealthcare.com, Sep 30, 2026 - The Illinois PDL search tool shows whether a medicine has quantity limits, age limits, or requires prior authorization.Molina Healthcare:
See if your medicine has quantity limits, has age limits, or requires Prior Authorization.
molinahealthcare.com, Sep 30, 2026
1 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
IndianaDoes not cover them for weight loss
Program: Indiana Health Coverage Programs. in.gov
Weight loss
- Indiana Medicaid member pharmacy page lists “Medications used for weight loss” among medications not covered. (Governor announced BALANCE participation on 7/30/2026, see changes; no implementing bulletin found as of the IHCP bulletin list checked 2026-09-27.)
The following medications are not covered by Indiana Medicaid: Medications made by manufacturers that do not participate in the Medicaid program Medications that do not have an FDA-approved use Medications that are not medically necessary Experimental or investigational medications Medications to help you get pregnant Medications used for weight loss
in.gov, Sep 30, 2026
Criteria
- Under-21 exception: IHCP bulletin BT2023148 (10/31/2023) covers weight-loss medications in select cases under EPSDT (details in the PDF bulletin).
BT2023148 10/31/2023 IHCP to cover weight-loss medications in select cases under EPSDT
in.gov, Sep 30, 2026
Changes
- July 30, 2026: Governor Braun directed FSSA to join the CMS Innovation Center BALANCE demonstration to expand access to select GLP-1 medications for eligible Medicaid members living with obesity.
Indiana Governor Mike Braun today directed the Indiana Family and Social Services Administration (FSSA) to participate in the Center for Medicare and Medicaid Innovation’s BALANCE demonstration, expanding access to select GLP-1 medications for eligible Indiana Medicaid members living with obesity.
events.in.gov, Sep 30, 2026 - Eligibility criteria and start timing were not yet announced.
Additional implementation details, including eligibility criteria and timing, will be announced as the agreement is finalized.
events.in.gov, Sep 30, 2026 - Release date of the announcement.
FOR IMMEDIATE RELEASE Thursday, July 30, 2026
events.in.gov, Sep 30, 2026
6 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
IowaDoes not cover them for weight loss
Program: Iowa Department of Health and Human Services. hhs.iowa.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 27, 2026. Our weekly check does not re-download files.
Weight loss
- Iowa Administrative Code 441-78.2(4)(b) (current rule text, “as amended to July 1, 2026”) says Iowa Medicaid does not pay for drugs used for weight loss. Source is the Iowa Legislature’s “RTF” download of rule 441.78.2, which is served as a Word (.docx) file; text extracted verbatim from its document body.
b. Payment is not made for: (1) Drugs whose prescribed use is not for a medically accepted indication as defined by Section 1927(k)(6) of the Social Security Act as amended to July 1, 2026. (2) Drugs used for anorexia, weight gain, or weight loss.
legis.iowa.gov, Sep 27, 2026
Changes
- Iowa HHS: starting December 1, 2026 the Medicaid pharmacy benefit moves from the MCOs to fee-for-service (a general pharmacy administration change, not GLP-1 specific).
Effective December 1, 2026, the Iowa Medicaid pharmacy benefit will be administered through Fee-for-Service instead of the Managed Care Organizations.
hhs.iowa.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- The official Iowa Medicaid PDL portal lists a separate PA form for incretin mimetics (GLP-1 class) used for non-diabetes indications; which indications (e.g. OSA, CV risk, MASH) qualify is stated only in PDFs.
Incretin Mimetics for Non-Diabetes Indications 470-0058
iowamedicaidpdl.com, Sep 30, 2026
5 more documents are PDFs, which we have not opened.
KansasCovers GLP-1s for weight loss
Program: Kansas Department of Health and Environment. kdhe.ks.gov
The criteria document was last revised in August 2024, with minor updates on June 1, 2025; the drug list is dated August 1, 2026.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Kansas Medicaid preferred drug list, last updated 08/01/2026 (a PDF), has an Anti-Obesity Medications class: Wegovy (injection and tablets), Wegovy HD and Zepbound are preferred; Saxenda is non-preferred and needs prior authorization.
Anti-Obesity Medications Preferred Non-Preferred, Prior Authorization Required Wegovy® (semaglutide) injection and tablets Saxenda® (liraglutide) injection Wegovy® HD (semaglutide) injection Zepbound® (tirzepatide) injection
kdhe.ks.gov, Sep 29, 2026 Last Updated: 08/01/2026
kdhe.ks.gov, Sep 29, 2026- KDHE’s approved Anti-Obesity Medications prior authorization criteria (a PDF; revised August 14, 2024, minor updates 6/1/2025) require prior authorization for Saxenda, Wegovy and Zepbound.
Prior authorization will be required for all current and future dose forms available*. All medication-specific criteria, including drug-specific indication, age, and dose for each agent is defined in Table 1 below. Liraglutide (Saxenda®) Semaglutide (Wegovy™) Tirzepatide (Zepbound™)
kdhe.ks.gov, Sep 29, 2026 Revised Dates: August 14, 2024; January 17, 2024; July 19, 2023; October 19, 2022; July 21, 2021; April 21, 2021; January 11, 2017; July 8, 2015; April 8, 2015; January 14, 2015; September 2014; April 9, 2014; October 10, 2012; June 15, 2011 Minor updates 6/1/2025
kdhe.ks.gov, Sep 29, 2026
Criteria
- Adults qualify with a BMI of 30 or more, or 27 or more with at least one weight-related condition listed in the criteria.
For Adults, must meet one of the following: ▪ BMI ≥ 30 kg/m2 ▪ BMI ≥ 27 kg/m2 AND has at least one weight-related comorbidity listed in Table 2.
kdhe.ks.gov, Sep 29, 2026 - The prescriber must give the patient’s baseline weight and BMI, and the treatment plan must include lifestyle changes (diet, physical activity and behavioral therapy).
Prescriber must provide the patient’s baseline weight and BMI. • The treatment plan includes comprehensive adjunct lifestyle interventions (e.g., diet modification, physical activity, and behavioral therapy).
kdhe.ks.gov, Sep 29, 2026 - The criteria’s extra section for “high-cost” agents does not apply to Zepbound (since 4/1/24) or Wegovy (since 6/1/25).
Note: This section does not apply for the following drugs: Zepbound®(as of 4/1/24), Wegovy®(as of 6/1/25)
kdhe.ks.gov, Sep 29, 2026 - That extra section (for the “high-cost” agents it still covers) requires adults to have severe obesity, a BMI of 40 or more.
Adults: BMI ≥ 40 kg/m2.
kdhe.ks.gov, Sep 29, 2026 - First approval for Zepbound and Wegovy lasts 28 weeks.
LENGTH OF APPROVAL: For Zepbound (as of 4/1/24) and Wegovy (as of 6/1/25): 28 weeks
kdhe.ks.gov, Sep 29, 2026 - One adult renewal option: a loss of 5% of starting weight at 12 weeks, kept off.
The patient has lost a total of 5% of pretreatment weight at 12 weeks and maintains the 5% weight loss.
kdhe.ks.gov, Sep 29, 2026 - KDHE’s Class-Specific Clinical Criteria page lists the “Anti-Obesity Medications” PA criteria document quoted above.
Anti-Obesity Medications (PDF)
kdhe.ks.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- The anti-obesity criteria also give Wegovy a heart-disease path: adults with a BMI of 27 or more and established cardiovascular disease, without type 1 or type 2 diabetes.
For Wegovy only: Adults with BMI ≥ 27 kg/m2 AND has established cardiovascular disease (CVD) and NOT have a history of type I nor type II diabetes.
kdhe.ks.gov, Sep 29, 2026 - KDHE lists separate PA criteria for obstructive sleep apnea agents.
Obstructive Sleep Apnea (OSA) Agents (PDF)
kdhe.ks.gov, Sep 30, 2026 - KDHE lists separate PA criteria for MASH agents.
Metabolic Dysfunction-Associated Steatohepatitis (MASH) Agents (PDF)
kdhe.ks.gov, Sep 30, 2026
Type 2 diabetes
- The same KDHE page lists separate PA criteria for type 2 diabetes agents.
Diabetes Mellitus Type 2 Agents (PDF)
kdhe.ks.gov, Sep 30, 2026
9 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
KentuckyDoes not cover them for weight loss
Program: Cabinet for Health and Family Services, Department for Medicaid Services, Pharmacy Policy Branch. chfs.ky.gov
Weight loss
- The regulation currently in effect, 907 KAR 23:010 Section 5, excludes from Kentucky Medicaid coverage drugs used for weight loss unless an Outpatient Drug List designates them as covered.
A drug or its medical use in one (1) of the following categories unless the drug or its medical use is designated as covered by an Outpatient Drug List: (a) A drug if used for anorexia, weight loss, or weight gain;
apps.legislature.ky.gov, Sep 30, 2026 - Section 5 heading of the current regulation.
Exclusions to Coverage. The following drugs shall be excluded from coverage and shall not be reimbursed:
apps.legislature.ky.gov, Sep 30, 2026 - 2026 HB 2 (enacted as Acts Ch. 179): the Legislature’s summary of the enacted version says it prohibits Medicaid coverage of prescription drugs prescribed primarily for weight loss.
prohibit the Medicaid program from providing coverage for prescription drugs when prescribed primarily for weight loss
apps.legislature.ky.gov, Sep 30, 2026
Changes
- DMS filed an amendment to 907 KAR 23:010 on September 9, 2025 that would have allowed weight-loss drugs.
This amendment will allow reimbursement for prescription weight loss, anorexia, and weight loss drugs.
apps.legislature.ky.gov, Sep 30, 2026 - Filing date of that amendment.
FILED WITH LRC: September 9, 2025 at 10:09 a.m.
apps.legislature.ky.gov, Sep 30, 2026 - The amended version (amended at ARRS) was found deficient by the legislature’s Administrative Regulation Review Subcommittee on February 9, 2026.
This administrative regulation was found deficient by the Administrative Regulation Review Subcommittee on February 9, 2026.
apps.legislature.ky.gov, Sep 30, 2026 - 2026 SB 65 (Acts Ch. 156, veto overridden) nullified the Medicaid outpatient pharmacy regulation amendment.
nullify an administrative regulation relating to the Medicaid outpatient pharmacy program
apps.legislature.ky.gov, Sep 30, 2026 - SB 65 became law.
04/14/26: delivered to Secretary of State (Acts Ch. 156)
apps.legislature.ky.gov, Sep 30, 2026 - KRS 13A.3451 (created by SB 65) makes 907 KAR 23:010 (the proposed amendment) unenforceable as of April 14, 2026.
.3451 Unenforceability of 907 KAR 23:010 as of April 14, 2026.
apps.legislature.ky.gov, Sep 30, 2026 - HB 2 (which contains the weight-loss-drug coverage prohibition) became law.
04/14/26: delivered to Secretary of State (Acts Ch. 179)
apps.legislature.ky.gov, Sep 30, 2026 - The regulation text in effect is still the 2017 version (certified 2024), i.e. without the weight-loss amendment.
HISTORY: (43 Ky.R. 2091, 44 Ky.R. 248; 536; eff. 10-6-2017; Cert eff. 7-22-2024.)
apps.legislature.ky.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Kentucky’s official Medicaid pharmacy portal (MedImpact) lists drug-specific PA criteria for Zepbound (effective 7/1/2025); the covered indication (e.g. OSA) is stated only in the PDF.
Zepbound PA Criteria - Effective 7.1.2025
kyportal.medimpact.com, Sep 30, 2026 - The portal lists drug-specific PA criteria for Wegovy (effective 1/3/2026); the covered indication (e.g. CV risk / MASH) is stated only in the PDF.
Wegovy PA Criteria - Effective 1.3.2026
kyportal.medimpact.com, Sep 30, 2026 - A 2026 provider communication on Zepbound formulations shows Zepbound is on the Kentucky Medicaid drug list for some approved use.
Zepbound KwikPen Preferred Formulation Update
kyportal.medimpact.com, Sep 30, 2026
8 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
LouisianaDoes not cover them for weight loss
Program: Louisiana Department of Health. ldh.la.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 27, 2026. Our weekly check does not re-download files.
Weight loss
- LDH’s Medicaid Services page lists “Anorexics (Except for Xenical)” among the drug categories the Medicaid pharmacy benefit does not cover; Xenical (orlistat), a non-GLP-1 weight-loss drug, is the only stated exception.
Covers prescription drugs, except: Cosmetic drugs (Except Accutane); Cough & cold preparations; Anorexics (Except for Xenical);
ldh.la.gov, Sep 30, 2026 - LDH Medicaid Services Manual Chapter 37 (Pharmacy Benefits Management), Section 37.1 - draft revision in LDH’s provider-manual public-comment folder dated 07_18_25 (Word file): agents used for weight loss are excluded from Medicaid coverage except orlistat (Xenical).
The following drugs and/or therapeutic categories are excluded from Medicaid coverage: Select agents when used for anorexia, weight loss, or weight gain with the exception of orlistat (Xenical);
ldh.la.gov, Sep 27, 2026
Changes
- 2026 Regular Session SB 433 (Medicaid coverage of certain medications, shown with a 1/1/27 date and a +$3,000,000 general-fund fiscal note) was signed as Act 898.
MEDICAID: Provides for Medicaid coverage of certain medications. (1/1/27) (EN +$3,000,000 GF EX See Note)
legis.la.gov, Sep 30, 2026 - SB 433 became Act 898.
Signed by the Governor. Becomes Act No. 898.
legis.la.gov, Sep 30, 2026 - Louisiana Medicaid GLP-1 RA criteria were updated effective November 15, 2024.
Louisiana Medicaid Pharmacy Updated Criteria for GLP-1 Receptor Agonists – Effective November 15, 2024
lamedicaid.com, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy has required clinical authorization since July 1, 2024 (the provider notice itself, PDF, describes the cardiovascular criteria).
Louisiana Medicaid Pharmacy Clinical Authorization for Semaglutide (Wegovy®) - Effective July 1, 2024
lamedicaid.com, Sep 30, 2026 - LDH posted Zepbound clinical criteria and a Zepbound patient agreement for public comment on 9/26/25 (status Complete).
2025-PHARM-158 Zepbound 9/26/25 11/10/25 Complete Zepbound 2025-PHARM-159 Zepbound Patient Agreement 9/26/25
ldh.la.gov, Sep 30, 2026
Type 2 diabetes
- Chapter 37.1 draft: incretin mimetics (GLP-1s) are subject to age, diagnosis-code, clinical authorization, quantity-limit and duplication edits.
Prescriptions for incretin mimetic/enhancers may be subject to the following:
ldh.la.gov, Sep 27, 2026 - Ozempic and Mounjaro have an 18-year minimum age edit.
Semaglutide (Ozempic®, Rybelsus®) 18 years Tirzepatide (Mounjaro®) 18 years
ldh.la.gov, Sep 27, 2026 - Select incretin mimetics require a diagnosis code on the claim (typo “claimes” is in the original).
Pharmacy claimes for select incretin mimetic/enhancers require a diagnosis code.
ldh.la.gov, Sep 27, 2026
9 more documents are PDFs, which we have not opened.
MaineDoes not cover them for weight loss
Program: Maine DHHS, Office of MaineCare Services. maine.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 27, 2026. Our weekly check does not re-download files.
Weight loss
- MaineCare PDL effective 7/1/2026 (official Excel version on mainecarepdl.org), Weight Loss category: weight-loss drugs are not covered.
Weight loss drugs are not covered as permitted by Federal Medicaid regulations and Maine Medicaid (MaineCare) Policy.
mainecarepdl.org, Sep 27, 2026 - MaineCare Benefits Manual Ch. II Section 80 (Pharmacy Services, Word file linked from the Secretary of State’s MaineCare Benefits Manual page): “certain weight loss drugs” are non-covered.
MaineCare does not reimburse for the following drugs or products as drugs: A. Anorexic, or certain weight loss drugs.
maine.gov, Sep 27, 2026
Sleep apnea, heart risk, MASH
- Zepbound is covered with PA only for moderate-to-severe OSA in adults with BMI >= 30 (not for T1DM/T2DM patients).
Zepbound for adults with a BMI ≥ 30 mg/kg2 and diagnosis of moderate to severe OSA, confirmed by sleep study within the last 3 years documenting AHI ≥ 15
mainecarepdl.org, Sep 27, 2026 - Wegovy injection is listed in the preferred column of the Cardiometabolic Health Agents class.
CARDIOMETABOLIC HEALTH AGENTS || MC/DEL || WEGOVY INJ1
mainecarepdl.org, Sep 27, 2026 MC/DEL || WEGOVY TAB1
mainecarepdl.org, Sep 27, 2026- Footnote 1 in that class: clinical PA is required to establish diagnosis and medical necessity.
1.Clinical PA is required to establish diagnosis and medical necessity.
mainecarepdl.org, Sep 27, 2026 - Cardiometabolic class indications include MACE reduction.
Indication for use is Major Adverse Cardiac Event (MACE) Reduction:
mainecarepdl.org, Sep 27, 2026 - Cardiometabolic class indications include MASH.
Indication for use is Metabolic Dysfunction-Associated Steatohepatitis (MASH):
mainecarepdl.org, Sep 27, 2026 - Wegovy criterion: BMI > 27 and not for weight loss only.
Wegovy: Patient has BMI > 27 kg/m2, and is not being used for weight loss only
mainecarepdl.org, Sep 27, 2026 - MaineCare has a dedicated semaglutide/MACE PA form.
Semaglutide/MACE PA Form
mainecarepdl.org, Sep 30, 2026
Type 2 diabetes
- 7/1/2026 PDL, Incretin Mimetic class: Rybelsus is in the preferred column and Ozempic in the non-preferred column (step order 6, PA form 20420).
INCRETIN MIMETIC || MC/DEL || RYBELSUS || MC/DEL || 6 || OZEMPIC || Use PA Form# 20420
mainecarepdl.org, Sep 27, 2026
3 more documents are PDFs, which we have not opened.
MarylandDoes not cover them for weight loss
Program: Maryland Department of Health, Maryland Medicaid Pharmacy Program. health.maryland.gov
Weight loss
- Maryland Medicaid pharmacy regulation (COMAR 10.09.03.05, Limitations) lists items that are not covered unless specifically identified as covered under Regulation .04.
A. Except as specifically identified as being covered under Regulation .04 of this chapter, the following are not covered:
regs.maryland.gov, Sep 30, 2026 - Item (14) of that not-covered list: drugs/injections used for weight control (fee-for-service exclusion of weight-loss agents).
(14) Oral drugs or injections for central nervous system stimulants, anorexigenics, and any other agents when used for weight control;
regs.maryland.gov, Sep 30, 2026 - HealthChoice managed care regulation (COMAR 10.67.06.27) lists benefits MCOs are not required to provide.
A. The benefits or services not required to be provided by an MCO are as follows:
regs.maryland.gov, Sep 30, 2026 - Item (12): MCOs are not required to cover anorectic agents used for controlling weight.
(12) Prescriptions or injections for central nervous system stimulants and anorectic agents when used for controlling weight;
regs.maryland.gov, Sep 30, 2026
Changes
- 2026 law SB 496 (Chapter 866) AUTHORIZES (does not require) Maryland Medicaid to provide comprehensive obesity-treatment coverage beginning January 1, 2027.
Authorizing, beginning January 1, 2027, the Maryland Medical Assistance Program to provide comprehensive coverage for the treatment of obesity
mgaleg.maryland.gov, Sep 30, 2026 - SB 496 status: enacted (became law without the Governor’s signature under Art. II Sec. 17(c)) as Chapter 866.
Enacted under Article II, Section 17(c) of the Maryland Constitution - Chapter 866
mgaleg.maryland.gov, Sep 30, 2026 - Provider transmittal PT 74-25: Zepbound coverage effective February 5, 2025 (indication stated only in the PDF).
Notice of Zepbound Coverage, Effective February 5, 2025
health.maryland.gov, Sep 30, 2026 - Provider transmittal PT 41-26 (Dec 2025): updated Wegovy criteria for adults with MASH.
Updated Clinical Criteria for Wegovy for Adults with Non-cirrhotic Metabolic Dysfunction-associated Steatohepatitis
health.maryland.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Provider transmittal PT 35-25: Wegovy covered for overweight/obese adults with cardiovascular disease, effective September 15, 2024 (title from the official Provider Transmittals list feed).
Coverage of Wegovy for Overweight or Obese Adults with Cardiovascular Disease, Effective September 15, 2024
health.maryland.gov, Sep 30, 2026 - Provider transmittal PT 74-25: notice of Zepbound coverage effective February 5, 2025 (the web page title does not name the indication; see PDF).
Notice of Zepbound Coverage, Effective February 5, 2025
health.maryland.gov, Sep 30, 2026 - Provider transmittal PT 41-26: Wegovy clinical criteria for adults with non-cirrhotic MASH.
Updated Clinical Criteria for Wegovy for Adults with Non-cirrhotic Metabolic Dysfunction-associated Steatohepatitis
health.maryland.gov, Sep 30, 2026 - Wegovy (injection and tablet) appears in the Maryland Medicaid Clinical Criteria index (criteria documents are PDFs).
Wegovy (semaglutide), Wegovy tablet (semaglutide)
health.maryland.gov, Sep 30, 2026
10 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
MassachusettsNot confirmed in the state's own pages
Program: MassHealth Drug List. mhdl.pharmacy.services.conduent.com
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 30, 2026. Our weekly check does not re-download files.
Changes
- MassHealth notice of public hearing (April 10, 2026): proposed changes to its pharmacy regulation, 130 CMR 406.000, would end coverage of drugs prescribed solely for obesity or overweight, except for children covered by EPSDT.
The second purpose of the proposed amendments is to end coverage of drugs prescribed solely for the treatment of obesity or overweight, except for children covered by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
sec.state.ma.us, Sep 30, 2026 - Same notice: the proposed regulations were planned to take effect no sooner than July 1, 2026.
The proposed regulations are planned to go into effect no sooner than July 1, 2026.
sec.state.ma.us, Sep 30, 2026 - Same notice: ending coverage of drugs prescribed solely for weight loss was estimated to save MassHealth $15 million a year, after rebates and federal share.
the elimination of coverage for drugs prescribed solely for weight loss is estimated to have an annual net fiscal impact of $15 million in savings for MassHealth, after rebates and federal share, for members enrolled in MassHealth fee-for-service and managed care entities.
sec.state.ma.us, Sep 30, 2026 - Same notice: it was a proposal, and the agency could adopt a revised version.
The Division may adopt a revised version of the proposed regulation, taking into account relevant comments and any other practical alternatives that come to its attention.
sec.state.ma.us, Sep 30, 2026 April 10, 2026
sec.state.ma.us, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Current MHDL Table 72 lists Wegovy (injection, tablet) as a preferred drug requiring PA.
semaglutide injection, tablet Wegovy PD PA
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Wegovy PA criteria exist for MACE risk reduction in adults with established cardiovascular disease and obesity/overweight.
Documentation of the following is required for Wegovy injection or tablet for the indication to reduce the risk of major adverse cardiovascular events (MACE) in adults with established cardiovascular disease and obesity or overweight:
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Wegovy PA criteria exist for NASH/MASH with F2-F3 fibrosis.
Documentation of the following is required for Wegovy injection for treatment of nonalcoholic steatohepatitis (NASH) or metabolic dysfunction associated steatohepatitis (MASH), with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis):
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Wegovy PA criteria exist for moderate-to-severe OSA in adults with obesity.
Documentation of the following is required for Wegovy injection for treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity:
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Zepbound’s only PA criteria in the current table are for moderate-to-severe OSA in adults with obesity.
Documentation of the following is required for Zepbound for treatment of moderate to severe OSA in adults with obesity:
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Zepbound row: PA required and no PD (preferred drug) flag, unlike Wegovy.
tirzepatide-Zepbound Zepbound PA
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 Last updated 09/21/26
mhdl.pharmacy.services.conduent.com, Sep 30, 2026- MassHealth prior authorization form for non-diabetic GIP/GLP-1 drugs (Wegovy injection or tablet, Zepbound) lists these indications: heart risk reduction (MACE), moderate to severe sleep apnea with obesity, and NASH with liver fibrosis.
Risk reduction of major adverse cardiovascular events (MACE) with established cardiovascular disease and obesity or overweight Moderate to severe obstructive sleep apnea (OSA) with obesity Nonalcoholic steatohepatitis (NASH) with moderate to advanced liver fibrosis
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Same form: for the sleep apnea indication, records must show an apnea-hypopnea index of at least 15 events per hour on a sleep study.
Please provide medical records documenting an apnea-hypopnea index (AHI) of at least 15 events per hour based on polysomnogram (PSG) or home sleep test (HST) confirming diagnosis of moderate to severe OSA.
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Same form: for Zepbound, records must show that semaglutide did not work after six months at the highest tolerated dose, caused a serious reaction, or cannot be used.
For Zepbound, please attach medical records documenting an inadequate response (at maximally tolerated dose for six months), adverse reaction (allergic in nature or cannot be expected or managed as part of GLP-1 therapy) or contraindication to semaglutide.
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 PA-87 (Rev. 08/26)
mhdl.pharmacy.services.conduent.com, Sep 30, 2026
Type 2 diabetes
- MassHealth Drug List Table 26: Ozempic is a preferred drug (PD) that requires PA.
semaglutide injection Ozempic PD PA
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - MassHealth Drug List Table 26: Mounjaro is a preferred drug (PD) that requires PA.
tirzepatide-Mounjaro Mounjaro PD PA
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - SmartPA: Ozempic/Mounjaro claims usually pay at the pharmacy without a PA request when the member has type 2 diabetes (or prediabetes) medical-claims history and recent GLP-1 claims.
Claims for liraglutide (generic Victoza), Mounjaro, Ozempic, and Trulicity within the quantity limit (described above) and polypharmacy requirements will usually process at the pharmacy without a PA request if the member has a history of medical claims for type 2 diabetes mellitus
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - Legend: PD = Preferred Drug.
Preferred Drug. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class.
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 - MassHealth Drug List summary update for October 1, 2026: the Ozempic tablet is added as a preferred drug (PD) that requires PA.
Ozempic (semaglutide tablet) PD – PA
mhdl.pharmacy.services.conduent.com, Sep 30, 2026 Effective October 1, 2026, the following newly marketed drugs have been added to the MassHealth Drug List.
mhdl.pharmacy.services.conduent.com, Sep 30, 2026
What Medicaid health plans in Massachusetts say
- For UnitedHealthcare Community Plan of Massachusetts (notice dated May 28, 2026), the affected drugs stay covered only for Medicare-covered conditions such as type 2 diabetes, cardiovascular disease or obstructive sleep apnea.UnitedHealthcare:
These drugs will continue to be covered for Medicare-covered conditions only, like type 2 diabetes, cardiovascular disease or obstructive sleep apnea. Any indication excluded by Medicare, including weight loss and obesity, will not be covered.
uhcprovider.com, Sep 30, 2026 - For UnitedHealthcare Community Plan of Massachusetts (May 28, 2026), the drugs remain covered for Medicare-covered conditions such as cardiovascular disease.UnitedHealthcare:
These drugs will continue to be covered for Medicare-covered conditions only, like type 2 diabetes, cardiovascular disease or obstructive sleep apnea. Any indication excluded by Medicare, including weight loss and obesity, will not be covered.
uhcprovider.com, Sep 30, 2026 - For UnitedHealthcare Community Plan of Massachusetts (May 28, 2026), the drugs remain covered for Medicare-covered conditions such as type 2 diabetes.UnitedHealthcare:
These drugs will continue to be covered for Medicare-covered conditions only, like type 2 diabetes, cardiovascular disease or obstructive sleep apnea. Any indication excluded by Medicare, including weight loss and obesity, will not be covered.
uhcprovider.com, Sep 30, 2026 - UHC notice dated May 28, 2026: beginning July 1, 2026, to comply with MassHealth, UnitedHealthcare Community Plan of Massachusetts no longer covers prescription drugs used to treat weight loss and obesity, for all its members.UnitedHealthcare:
Beginning July 1, 2026, to comply with MassHealth, we’ll no longer cover prescription drugs used for the treatment of weight loss and obesity. This change applies to all UnitedHealthcare Community Plan of Massachusetts members.
uhcprovider.com, Sep 30, 2026
12 of the state's pages blocked automated reading.
MichiganCovers them only in narrow cases
Program: MDHHS fee-for-service pharmacy benefit is administered through Prime Therapeutics. michigan.gov
Based on the state budget law.
Weight loss
- FY2026 budget law (Public Act 22 of 2025, Sec. 1880(2)) requires MDHHS to limit authorization of anti-obesity GLP-1s exclusively to people classified as morbidly obese (coverage continues only for that narrow group).
(2) The department shall revise existing pharmacy coverage policies to limit the authorization of anti-obesity GLP-1 receptor agonists exclusively to individuals classified as morbidly obese.
legislature.mi.gov, Sep 30, 2026 - MDHHS provider letter L 25-73 (Dec 8, 2025) updated pharmacy coverage for treatment of obesity (the letter itself is a PDF; its effective date is not stated on its web pages).
L 25-73 December 8, 2025 Update of Pharmacy Drug Coverage for Treatment of Obesity All Providers
michigan.gov, Sep 30, 2026
Criteria
- Statutory conditions: documented failure of all other clinically appropriate weight-loss interventions, and use only to avert higher-cost bariatric surgery.
Coverage is contingent on documented failure of all other clinically appropriate weight-loss interventions and must be considered only as a measure to avert the need for higher-cost bariatric surgery.
legislature.mi.gov, Sep 30, 2026
Changes
- Public Act 22 of 2025 approved by the Governor October 7, 2025 (MDHHS then issued L 25-73 on Dec 8, 2025; effective date only in the PDF).
Approved by the Governor October 7, 2025
legislature.mi.gov, Sep 30, 2026 - FY2026-27 budget law (Public Act 21 of 2026, Sec. 1880(2)): if MDHHS does not join a federal pharmaceutical savings program this fiscal year, anti-obesity GLP-1 authorization is limited to people with class III obesity.
(2) If the department does not participate in a federal pharmaceutical savings program during the current fiscal year, the department shall revise existing pharmacy coverage policies to limit the authorization of anti-obesity GLP-1 receptor agonists exclusively to individuals classified as class III obesity.
legislature.mi.gov, Sep 30, 2026 - Public Act 21 of 2026 approved July 21, 2026.
Approved by the Governor July 21, 2026
legislature.mi.gov, Sep 30, 2026
6 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
MinnesotaCovers GLP-1s for weight loss
Program: Minnesota Medical Assistance drug-coverage statute. revisor.mn.gov
The criteria come from the Minnesota DHS page, which blocks automated reading; we read it in a browser on Sep 28, 2026.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- Minnesota DHS prior authorization criteria for anti-obesity medications (dated August 2026): Saxenda, Wegovy and Zepbound are among the covered drugs, with prior authorization.
Covered drugs with prior authorization: Benzphetamine Contrave Diethylpropion or diethylpropion ER Lomaira Orlistat Phendimetrazine or phendimetrazine ER Phentermine capsules (Apidex-P and generics): 15mg, 30mg, 37.5mg Phentermine tablets (Apidex-P and generics): 37.5mg Saxenda Wegovy Xenical Zepbound
mn.gov, Sep 28, 2026 - Minnesota’s preferred drug list (effective May 1, 2026) has a Weight Management Agents class: Saxenda and Wegovy preferred, Zepbound nonpreferred.
WEIGHT MANAGEMENT AGENTS section updated 12-1-2024 Preferred Nonpreferred SAXENDA (SUBCUTANEOUS) ORLISTAT (ORAL) WEGOVY (SUBCUTANEOUS) XENICAL (ORAL) ZEPBOUND (SUBCUTANEOUS)
mn.gov, Sep 28, 2026 - Minnesota House of Representatives “Session Daily” (official House news, March 25, 2026; not DHS): Medical Assistance coverage of weight-loss drugs continues, after HF 4142 (which would have banned it) was laid over. DHS pages could not be read, so this rests on the Legislature’s source and should be re-checked on DHS in a browser.
Medical Assistance coverage of weight loss drugs can continue for now
house.mn.gov, Sep 30, 2026 - Same story: MA pays for these drugs (Ozempic, Wegovy, Mounjaro named) at about $12,000 per patient per year, over 12% of state pharmacy costs.
As names like Ozempic, Wegovy and Mounjaro have gained popularity in recent years, Minnesota’s cost per Medical Assistance patient using these drugs surged, now costing $12,000 per person per year and representing more than 12% of the state’s pharmaceutical costs.
house.mn.gov, Sep 30, 2026
Criteria
- Adults need a BMI of 30 or more, or 27 or more with at least one weight-related condition such as high blood pressure, type 2 diabetes or abnormal cholesterol.
Greater than or equal to 30 kg/m2 with no risk factors (for patient at least 18 years of age) OR Greater than or equal to 27 kg/m2 with at least one weight-related comorbid condition (e.g. hypertension, type 2 diabetes mellitus, or dyslipidemia) (for patient at least 18 years of age)
mn.gov, Sep 28, 2026 - To renew, adults must have lost at least 5% of their weight during the first approval period.
Patient, at least 18 years of age, must have at least 5% weight loss during the initial approval period
mn.gov, Sep 28, 2026 - The first approval for Wegovy or Saxenda lasts 6 months and can be renewed.
6 months for Saxenda, Wegovy, Contrave, Xenical or orlistat; and may be renewed if renewal criteria is met.
mn.gov, Sep 28, 2026
Changes
- Minnesota House Session Daily (official House site), March 25, 2026: headline says MA coverage of weight-loss drugs can continue for now.
Medical Assistance coverage of weight loss drugs can continue for now
house.mn.gov, Sep 30, 2026 - HF 4142, which would prohibit MA coverage of drugs used solely for weight loss, was laid over by the House Health Finance and Policy Committee.
A bill he sponsors, HF4142, that would prohibit Medical Assistance coverage of prescription drugs solely used for weight loss, was laid over Wednesday by the House Health Finance and Policy Committee.
house.mn.gov, Sep 30, 2026 - HF 4142 as introduced would add a formulary exclusion for weight-loss-only drugs, effective Jan 1, 2027 or upon federal approval.
(6) drugs or active pharmaceutical ingredients when used only for weight loss; and
revisor.mn.gov, Sep 30, 2026 - HF 4142 status page shows only the introduced version (no later engrossment/enactment found).
Current bill text: As Introduced
revisor.mn.gov, Sep 30, 2026 - Current statute’s formulary exclusion list (Minn. Stat. 256B.0625 subd. 13d(b)) ends with medical cannabis; it contains no weight-loss exclusion.
(6) medical cannabis flower as defined in section 342.01, subdivision 54, or medical cannabinoid products as defined in section 342.01, subdivision 52.
revisor.mn.gov, Sep 30, 2026 - Minn. Stat. 256B.0625 recent history: the 2026 session amended subdivisions 4, 5m, 8, 17, 17b, 18i, 20, 47 and added 77 and 78; subdivision 13/13d (drug coverage / formulary exclusions) is not among them, so no 2026 statutory weight-loss drug exclusion was enacted.
Recent History 2026 Subd. 4 Amended 2026 c 95 art 9 s 7 2026 Subd. 5m Amended 2026 c 121 art 7 s 48 2026 Subd. 5m Amended 2026 c 95 art 5 s 27 2026 Subd. 8 Amended 2026 c 127 art 5 s 8 2026 Subd. 17 Amended 2026 c 121 art 10 s 1 2026 Subd. 17 Amended 2026 c 121 art 3 s 27 2026 Subd. 17b Amended 2026 c 121 art 10 s 2 2026 Subd. 18i Amended 2026 c 121 art 3 s 28 2026 Subd. 20 Amended 2026 c 121 art 3 s 29 2026 Subd. 47 Amended 2026 c 95 art 5 s 28 2026 Subd. 77 New 2026 c 95 art 4 s 13 2026 Subd. 78 New 2026 c 121 art 6 s 16
revisor.mn.gov, Sep 30, 2026
3 of the state's pages blocked automated reading.
MississippiCovers GLP-1s for weight loss
Program: Mississippi Division of Medicaid, Drug Prior Authorization page. medicaid.ms.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- Mississippi Medicaid covers selected obesity medicines, with prior authorization.
Mississippi Medicaid covers select agents for this condition. Coverage, subject to prior authorization, is outlined below.
medicaid.ms.gov, Sep 28, 2026 - Mississippi Medicaid Universal PDL web page (effective 7/01/2025, updated 7/30/2025, so it may predate later changes) lists Saxenda and Wegovy as PREFERRED “Antiobesity Select Agents” (orlistat/Xenical non-preferred), all with manual PA.
ANTIOBESITY SELECT AGENTS PREFERRED AGENTS NON-PREFERRED AGENTS PA CRITERIA SAXENDA (liraglutide) orlistat All agents MANUAL PA required WEGOVY (semaglutide) XENICAL (orlistat)
medicaid.ms.gov, Sep 30, 2026 EFFECTIVE 7/01/2025 VERSION 2025_7 Updated 7/30/2025
medicaid.ms.gov, Sep 30, 2026- CMS approved Mississippi SPA 23-0013, adding Medicaid coverage of selected drugs that treat obesity effective July 1, 2023 (the web page does not name the drugs; drug names and criteria are only in PDFs).
State Plan Amendment (SPA) 23-0013 Drugs to Treat Obesity was submitted to add coverage for selected drugs that treat obesity, effective July 1, 2023.
medicaid.ms.gov, Sep 30, 2026 - Page title confirms CMS approval.
MS SPA 23-0013 Drugs to Treat Obesity approved by CMS
medicaid.ms.gov, Sep 30, 2026 - The current Drug PA page lists an “Anti-Obesity Select Agents” PA packet updated 7/1/2026 (coverage ongoing, subject to PA).
Anti-Obesity Select Agents 7/1/2026
medicaid.ms.gov, Sep 30, 2026
Criteria
- Mississippi Medicaid prior authorization criteria (from July 1, 2026): preferred agents are Saxenda or Wegovy from age 12 and Foundayo and Zepbound from age 18.
Saxenda or Wegovy for ages 12 years and older Foundayo and Zepbound for ages 18 years and older
medicaid.ms.gov, Sep 28, 2026 - Only one obesity medicine is covered at a time.
Coverage of select medications for the treatment of obesity will be limited to only one covered product at a given time.
medicaid.ms.gov, Sep 28, 2026 - Obesity medicines are not covered during pregnancy or breastfeeding.
Mississippi Medicaid does not cover medications for treatment of obesity during pregnancy or for mothers who are breast-feeding.
medicaid.ms.gov, Sep 28, 2026
Sleep apnea, heart risk, MASH
- Separate PA criteria packet for Wegovy in MASH (updated 10/30/2025).
Wegovy in Metabolic Dysfunction-Associated Steatohepatitis 10/30/2025
medicaid.ms.gov, Sep 30, 2026
Type 2 diabetes
- 7/2025 web PDL, Hypoglycemics/Incretin Mimetics class: preferred-agent criteria require a documented type 2 diabetes diagnosis and no Saxenda/Wegovy in the past 30 days (or continuing therapy).
Preferred Criteria · Documented diagnosis of Type 2 Diabetes AND · No history of SAXENDA or WEGOVY in the past 30 days OR
medicaid.ms.gov, Sep 30, 2026 - In the same 7/2025 web PDL table, MOUNJARO and OZEMPIC sit in the NON-PREFERRED AGENTS column.
MOUNJARO (tirzepatide) OZEMPIC (semaglutide)
medicaid.ms.gov, Sep 30, 2026 - Non-preferred criteria (7/2025 PDL): T2D diagnosis plus prior Trulicity and Byetta/Victoza therapy, or continuing therapy.
Non-Preferred Criteria · Documented diagnosis of Type 2 Diabetes AND · No history of SAXENDA or WEGOVY in the past 30 days AND · 84 days of therapy with TRULICITY in the past 6 months
medicaid.ms.gov, Sep 30, 2026
5 more documents are PDFs, which we have not opened.
MissouriCovers GLP-1s for weight loss
Program: Missouri Department of Social Services, MO HealthNet Division. dss.mo.gov
Based on an October 2025 provider newsletter. A newer drug-list rule took effect in April 2026; its terms are in a Word file.
Weight loss
- MO HealthNet provider newsletter (sent by the Missouri Department of Social Services on 10/01/2025): Zepbound is the preferred drug in its GLP-1 “Indicated for Obesity” drug-list class.
Zepbound® is the preferred agent in the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit
content.govdelivery.com, Sep 30, 2026 Missouri Department of Social Services sent this bulletin at 10/01/2025 11:47 AM CDT
content.govdelivery.com, Sep 30, 2026- MO HealthNet’s clinical edits/PDL index lists a PDL edit for GLP-1s indicated for obesity, effective 04/23/2026.
04/23/2026 Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit
dss.mo.gov, Sep 30, 2026 - Pharmacy page lists a single PA form covering GLP-1s for all indications (form 2575-053; PDF).
GLP-1 Receptor Agonists for All Indications Prior Authorization
dss.mo.gov, Sep 30, 2026
Criteria
- An obesity diagnosis code on the pharmacy claim may get approval without prior authorization; otherwise prior authorization with clinical criteria is needed (October 2025 newsletter; the criteria themselves are in a Word file we have not opened).
Submission of a relevant, billable ICD-10 code for obesity on the pharmacy point of sale transaction may allow transparent approval without the need for prior authorization. Otherwise, a prior authorization for clinical criteria will be required.
content.govdelivery.com, Sep 30, 2026 - MO HealthNet covers only one GLP-1 claim per month (October 2025 newsletter).
MO HealthNet will only cover one GLP-1 claim per month.
content.govdelivery.com, Sep 30, 2026 - People using Mounjaro under the obesity class must switch to Zepbound (October 2025 newsletter).
Participants currently utilizing Mounjaro® (tirzepatide) will be required to utilize Zepbound (tirzepatide).
content.govdelivery.com, Sep 30, 2026
Changes
- Historical (hot tip dated 10/17/2022): at that time MHD did not cover drugs prescribed for weight loss. The 2026 obesity PDL edit above indicates this has since changed, but the current terms are only in the .docx edit.
MHD does not cover drugs prescribed for weight loss.
dss.mo.gov, Sep 30, 2026 - MO HealthNet bulletin 49-01 (07/08/2026) sets pharmacy copay policy for the federal GLP-1 Bridge program (bulletin text is a Word file we have not opened).
MORx Policy Regarding CMS GLP-1 Bridge Demonstration Program Copayments Date 07/08/2026 49-01
dss.mo.gov, Sep 30, 2026
Type 2 diabetes
- October 2025 newsletter: Ozempic, Trulicity and Victoza are the preferred diabetes GLP-1s, with no prior authorization or diagnosis required. The diabetes class was updated on 07/23/2026 in a Word file we have not opened.
Ozempic®, Trulicity®, and Victoza® are preferred agents in the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit All three (3) preferred agents are available with no prior authorization or diagnosis required.
content.govdelivery.com, Sep 30, 2026 - Diabetes GLP-1 PDL edit effective 07/23/2026 (content .docx). Older 2024 hot tip named Victoza, Trulicity, Byetta as preferred (outdated).
07/23/2026 Glucagon-Like Peptide -1 (GLP-1) Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit
dss.mo.gov, Sep 30, 2026
8 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
MontanaDoes not cover them for weight loss
Program: Montana DPHHS, Montana Healthcare Programs. medicaidprovider.mt.gov
Weight loss
- Montana Healthcare Programs Prescription Drug Program provider manual: the program does not pay for drugs prescribed for weight reduction.
What Drugs and Pharmaceutical Supplies Are Not Covered? The Montana Healthcare Programs Prescription Drug Program does not reimburse for the following items or services: Drugs supplied by drug manufacturers who have not entered into a federal drug rebate agreement. Drugs supplied by other public agencies such as the United States Veterans Administration, United States Department of Health and Human Services, local health departments, etc. Drugs for Medicare Part D dual eligible members, except for drugs covered in #5 in the What Drugs and Pharmaceutical Supplies Are Covered? section above. Drugs prescribed: To promote fertility For erectile dysfunction For weight reduction For cosmetic purposes or hair growth
medicaidprovider.mt.gov, Sep 30, 2026 Updated 07/09/2026 Complete Prescription Drug Program Manual
medicaidprovider.mt.gov, Sep 30, 2026
8 more documents are PDFs, which we have not opened.
NebraskaDoes not cover them for weight loss
Program: Nebraska DHHS, Division of Medicaid & Long-Term Care. dhhs.ne.gov
The state page we read is not dated.
Weight loss
- Nebraska DHHS “Medicaid Services” page: Medicaid will not cover drugs or items prescribed or recommended for weight control or appetite suppression. The page shows no date.
Medicaid will not cover services such as: acupuncture treatment; reversal of sterilization; sex change procedures; drugs or items prescribed or recommended for weight control and/or appetite suppression.
dhhs.ne.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Nebraska Medicaid PBM portal (Prime Therapeutics for NE DHHS) lists PA forms titled “Anti-Obesity Medication” for Wegovy and Zepbound.
Anti-Obesity Medication (Wegovy) Anti-Obesity Medication (Zepbound)
nebraska.fhsc.com, Sep 30, 2026
7 more documents are PDFs, which we have not opened.
NevadaDoes not cover them for weight loss
Program: Nevada Health Authority. nevadamedicaid.nv.gov
Based on the Medicaid Services Manual chapter 1200 effective Aug 31, 2026. Wegovy (heart risk, MASH) and Zepbound (sleep apnea) are covered for those uses with prior authorization.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 30, 2026. Our weekly check does not re-download files.
Weight loss
- Nevada Medicaid Services Manual, Chapter 1200 Prescribed Drugs (revisions effective August 31, 2026), section 1203: agents used for weight management are first on the list of excluded drugs.
1. Agents used for weight management. 2. Agents used to promote fertility.
nevadamedicaid.nv.gov, Sep 30, 2026 C. Excluded Nevada Medicaid will not reimburse for the following pharmaceuticals:
nevadamedicaid.nv.gov, Sep 30, 2026- Same manual, Incretin Mimetics (GLP-1) criteria: approval requires that the drug is not being prescribed for weight loss without a type 2 diabetes indication.
Medication is not being prescribed for weight loss in absence of T2DM indication;
nevadamedicaid.nv.gov, Sep 30, 2026 These revisions were heard and approved through the Public Hearing process pursuant to Nevada Revised Statutes (NRS) 422.2369 on August 25, 2026, and became effective August 31, 2026.
nevadamedicaid.nv.gov, Sep 30, 2026- The older Nevada Medicaid and Check Up Pharmacy Manual (updated June 7, 2022) also lists agents used for weight loss first among drugs the Nevada Medicaid Drug Rebate Program will not reimburse.
The Nevada Medicaid Drug Rebate Program will not reimburse for the following pharmaceuticals: Agents used for weight loss
medicaid.nv.gov, Sep 30, 2026 Updated: 06/07/2022 (pv04/14/2022)
medicaid.nv.gov, Sep 30, 2026
Changes
- Nevada SB 244 (2025 bill; legislature text): would have required Medicaid to cover certain obesity treatments.
Requires Medicaid to provide coverage of certain treatments for obesity. (BDR 38-206)
leg.state.nv.us, Sep 30, 2026 - SB 244’s digest: Section 2 would have required the Medicaid preferred drug list to include FDA-approved drugs for chronic weight management in people diagnosed with obesity.
Section 2 of this bill requires that list to include prescription drugs approved by the United States Food and Drug Administration with an indication for chronic weight management in patients who have been diagnosed with obesity.
leg.state.nv.us, Sep 30, 2026 - SB 244’s last history entry (June 3, 2025) reads “No further action taken”, so it did not become law.
Jun 03, 2025 (No further action taken.)
leg.state.nv.us, Sep 30, 2026 - Nevada Medicaid Web Announcement 3337 (April 22, 2024): Nevada Medicaid added coverage of Wegovy for its FDA heart-risk indication, with prior authorization.
Nevada Medicaid has updated policy to include coverage of Wegovy for this new indication in recipients who meet required prior authorization criteria in-line with FDA package labeling.
medicaid.nv.gov, Sep 30, 2026 April 22, 2024 Web Announcement 3337
medicaid.nv.gov, Sep 30, 2026- Nevada Medicaid’s fiscal note on SB 244 said the bill would have required the agency to expand coverage to FDA-approved drugs for chronic weight management.
Specifically, the bill would require the Division to expand coverage to include FDA approved prescription drugs for chronic weight management.
leg.state.nv.us, Sep 30, 2026 - The same fiscal note estimated $64.5 million in new state General Fund costs for fiscal years 2026 and 2027.
In sum, the addition of weight management prescription drug coverage would result in $64,503,729 in new General Fund costs for Medicaid for FY26/27.
leg.state.nv.us, Sep 30, 2026 Date Prepared: March 9, 2025
leg.state.nv.us, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Same Chapter 1200 manual: Wegovy can be approved to lower the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and obesity or overweight.
Medication is being prescribed for risk reduction of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight.
nevadamedicaid.nv.gov, Sep 30, 2026 - For that heart indication the member must be 18 or older and have a BMI of 27 or more.
Recipient must be 18 years of age or older; and c. Documentation that recipient has a body mass index (BMI) ≥27 kg/m2
nevadamedicaid.nv.gov, Sep 30, 2026 - For that heart indication Wegovy must be prescribed by or with a cardiologist or vascular specialist.
Wegovy® must be prescribed by, or in consultation with, a cardiologist or vascular specialist; and
nevadamedicaid.nv.gov, Sep 30, 2026 - For both the Wegovy heart indication and the Zepbound sleep apnea indication, the member must not have type 1 or type 2 diabetes.
Recipient must not have type 1 or type 2 diabetes. Recipients with type 1 or type 2 diabetes must have appropriate diabetic care with an alternative therapy as this indication is specific to non-diabetic recipients
nevadamedicaid.nv.gov, Sep 30, 2026 - Same manual: Zepbound can be approved for adults with obesity and moderate to severe obstructive sleep apnea (OSA) confirmed as the manual defines.
Medication is being prescribed for moderate to severe obstructive sleep apnea (OSA) in adults with obesity
nevadamedicaid.nv.gov, Sep 30, 2026 - For Zepbound for sleep apnea the member’s BMI must be over 30.
Documentation that the recipient has a body mass index (BMI) >30 kg/m2; and
nevadamedicaid.nv.gov, Sep 30, 2026 - Same manual, MASH section: Wegovy can be approved for noncirrhotic MASH with liver fibrosis stage 2 or 3 confirmed by biopsy or imaging (the criteria also require age 18 or older).
2. Wegovy® a. Initial Request: 1. Recipient has a diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis stage 2 or 3
nevadamedicaid.nv.gov, Sep 30, 2026
Type 2 diabetes
- Same manual, Incretin Mimetics: GLP-1 drugs can be approved to improve blood sugar in type 2 diabetes, or to lower heart risk in type 2 diabetes with established cardiovascular disease.
Adjunct to diet and exercise to improve glycemic control in recipients with type 2 diabetes mellitus (T2DM); or 2. Reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in recipients with type 2 diabetes and established cardiovascular disease; and
nevadamedicaid.nv.gov, Sep 30, 2026 - Same criteria: an HbA1c result from the past 180 days is required.
Documentation of A1C lab results within past 180 days; and
nevadamedicaid.nv.gov, Sep 30, 2026
3 of the state's pages blocked automated reading.
New HampshireDoes not cover them for weight loss
Program: NH Department of Health and Human Services, Division of Medicaid Services. nhmmis.nh.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- New Hampshire Medicaid notice to providers (dated October 9, 2025): from January 1, 2026, Medicaid no longer covers GLP-1 drugs prescribed only for weight loss; they stay covered for other chronic health conditions.
Effective January 1, 2026, New Hampshire Medicaid will no longer cover GLP-1 medications when prescribed solely for weight loss. These medications will continue to be covered when prescribed for other chronic health conditions.
nhmmis.nh.gov, Sep 28, 2026 - The same notice names Saxenda, Wegovy and Zepbound (and any generic versions): Medicaid no longer pays for them when prescribed only for weight loss.
GLP-1 medications (such as Saxenda, Wegovy, and Zepbound and any generic versions) will no longer be reimbursed by Medicaid if prescribed exclusively for weight loss purposes.
nhmmis.nh.gov, Sep 28, 2026
Changes
- NH Medicaid MMIS posted the provider notice “Change in Medicaid Coverage for GLP-1 Medications” on 10/15/2025 (quoted above; the notice itself is dated October 9, 2025).
10/15/2025 Change in Medicaid Coverage for GLP-1 Medications
nhmmis.nh.gov, Sep 30, 2026 - 2026 bill SB 455 would have required Medicaid coverage of GLP-1s for BMI>=30 or >=27 with comorbidity.
This bill directs the department of health and human services to provide coverage for GLP-1 medication under the state Medicaid plan if such medication is medically necessary for a patient based on certain health conditions.
gc.nh.gov, Sep 30, 2026 - SB 455 passed the Senate but the House voted it Inexpedient to Legislate on 05/14/2026 (i.e., it did not become law).
Inexpedient to Legislate: MA VV 05/14/2026 HJ 13 P. 26
gc.nh.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Coverage stays the same for other chronic conditions, such as type 2 diabetes, major adverse cardiovascular events (MACE), severe obstructive sleep apnea and MASH.
Coverage will remain unchanged for members using GLP-1s as part of a treatment plan for other chronic health conditions such as the treatment of type 2 diabetes, major adverse cardiovascular events (MACE), severe obstructive sleep apnea and Metabolic Dysfunction-Associated Steatohepatitis (MASH).
nhmmis.nh.gov, Sep 28, 2026
1 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
New JerseyDoes not cover them for weight loss
Program: NJ Department of Human Services, Division of Medical Assistance and Health Services. nj.gov
Based on a 2025 memo; we found no 2026 state page, and a 2026 bill to require coverage has not passed.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- NJ Human Services memo to the Legislature (cost estimates developed in August 2025): NJ FamilyCare covers drugs indicated for weight loss only in certain limited circumstances, such as when GLP-1s are prescribed for FDA-approved uses other than weight loss.
Under existing federal and state law, NJ FamilyCare already provides coverage of drugs indicated for weight loss in certain limited circumstances. These include when drugs (including Glucagon-like peptide-1 agonists or GLP-1s) are prescribed for FDA-approved indications other than weight loss.
nj.gov, Sep 28, 2026 - The memo projects what full coverage of weight-loss drugs in NJ FamilyCare would cost in state fiscal year 2026, as a study the SFY 2026 budget asked for, not a coverage change.
The table below projects the cost of full coverage of drugs for the treatment of weight loss in the NJ FamilyCare program in SFY 2026.
nj.gov, Sep 28, 2026
Criteria
- Children: coverage of weight-loss drugs is also required in some cases under the federal EPSDT benefit for children.
Coverage of weight loss drugs is also required in certain cases as part of federal requirements to cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children.
nj.gov, Sep 28, 2026
Changes
- The memo’s estimates date from August 2025.
These estimates were developed in August 2025 and are subject to change as new information becomes available.
nj.gov, Sep 28, 2026 - DMAHS posts the memo “NJ FamilyCare Coverage of Weight Loss Drugs” on its news page (quoted above).
Memo - NJ FamilyCare Coverage of Weight Loss Drugs
nj.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy is covered when clinically appropriate for cardiovascular disease, and Zepbound for sleep apnea.
For instance, Wegovy is covered when clinically appropriate for cardiovascular disease, and Zepbound is covered for sleep apnea.
nj.gov, Sep 28, 2026
New MexicoDoes not cover them for weight loss
Program: New Mexico Health Care Authority. hca.nm.gov
Weight loss
- HCA “Weight Reduction Medications” page (Fee-for-Service; page dateModified 2025-03-04) has a two-column table. The column headed “Not Covered by New Mexico Medicaid” contains exactly this cell text.
Imcivree (setmelanotide) Saxenda (liraglutide) Wegovy (semaglutide) Zepbound (tirzepatide)
hca.nm.gov, Sep 30, 2026 Not Covered by New Mexico Medicaid
hca.nm.gov, Sep 30, 2026- Only older (non-GLP-1) weight drugs are covered with PA under FFS (benzphetamine, phentermine, phendimetrazine, orlistat, etc.).
Some weight loss medications for treating obesity are covered under the New Mexico Medicaid Fee-for-Service program with prior authorization.
hca.nm.gov, Sep 30, 2026
Criteria
- PA criteria on the page apply to the covered (non-GLP-1) weight drugs, not to Wegovy/Zepbound.
BMI >40 or BMI > 35 with additional risk factors (hypertension, diabetes, dyslipidemia), and
hca.nm.gov, Sep 30, 2026
Changes
- A statewide PDL is being implemented in 2026.
In 2026 New Mexico Health Care Authority will implement a statewide Preferred Drug List (PDL) designed to streamline medication access for Medicaid members and simplify prescribing practices.
hca.nm.gov, Sep 30, 2026
3 more documents are PDFs, which we have not opened.
New YorkDoes not cover them for weight loss
Program: New York State Department of Health, NYRx. health.ny.gov
Weight loss
- NYRx (NY Medicaid pharmacy program, FFS for all members incl. managed care since 2023) does not cover Wegovy/Ozempic for weight loss (FAQ published July 26, 2023).
At this time, NYRx does not cover medications, such as Wegovy or Ozempic, when indicated for the treatment of weight loss.
health.ny.gov, Sep 30, 2026 - Jan 2025 Medicaid Update: weight-loss drugs are a statutory exclusion.
Drugs used for the treatment of anorexia, weight loss or weight gain pursuant to Social Security Act (SSA) §1927(d)(2).
health.ny.gov, Sep 30, 2026 - Jan 2025 Medicaid Update lists “Wegovy 0.25 mg/0.5 ml pen” and “Zepbound 2.5 mg/0.5 ml pen” as “State Plan exclusion” with this explanation.
Indications for weight loss are not covered pursuant to SSA §1927(d)(2).
health.ny.gov, Sep 30, 2026
Changes
- April 2025 Medicaid Update repeats the weight-loss exclusion (no change found in 2025/2026 web sources).
Drugs used for the treatment of anorexia, weight loss or weight gain pursuant to Social Security Act (SSA) §1927(d)(2);
health.ny.gov, Sep 30, 2026
2 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
North CarolinaCovers GLP-1s for weight loss
Program: NC Medicaid, Division of Health Benefits. medicaid.ncdhhs.gov
Weight loss
- Obesity coverage of GLP-1s was reinstated effective Dec. 12, 2025 (latest official bulletin found).
In accordance with the Governor’s directive, NC Medicaid coverage for GLP-1s for the treatment of obesity is being reinstated effective Dec. 12, 2025.
medicaid.ncdhhs.gov, Sep 30, 2026 - Wegovy is the preferred weight-management GLP-1; Zepbound and Saxenda are non-preferred.
Wegovy is a Preferred Product. Zepbound and Saxenda are Non-Preferred Products.
medicaid.ncdhhs.gov, Sep 30, 2026 - Bulletin covers both Medicaid Direct (FFS) and managed care.
This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
medicaid.ncdhhs.gov, Sep 30, 2026
Criteria
- Prior authorization under the restored weight-management clinical criteria (criteria in place as of Sept. 30, 2025, effective Aug. 1, 2024); step through Wegovy for Zepbound/Saxenda. BMI thresholds are in the NCTracks criteria document, not on this page.
Coverage of GLP-1s for Weight Management will revert to the criteria in place as of Sept. 30, 2025, restoring access to medications previously available under the NC Medicaid Outpatient Pharmacy Prior Approval Criteria GLP-1s for Weight Management, effective Aug. 1, 2024.
medicaid.ncdhhs.gov, Sep 30, 2026 - Step therapy: must try and fail Wegovy before Zepbound or Saxenda.
Beneficiaries must try and fail the preferred agent Wegovy OR have a documented reason why they cannot take the preferred medication in order for NC Medicaid to approve Zepbound or Saxenda.
medicaid.ncdhhs.gov, Sep 30, 2026
Changes
- Obesity coverage was discontinued effective Oct. 1, 2025 due to state funding shortfalls.
Given shortfalls in state funding, effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity, which is an optional benefit for Medicaid programs, will be discontinued.
medicaid.ncdhhs.gov, Sep 30, 2026 - Wegovy, Zepbound and Saxenda were removed from the PDL on Oct. 1, 2025.
Effective Oct. 1, 2025, Wegovy, Zepbound and Saxenda will be removed from the Preferred Drug List (PDL) as an off-cycle change.
medicaid.ncdhhs.gov, Sep 30, 2026 - Coverage restored effective Dec. 12, 2025 and the drugs were added back to the PDL.
Wegovy, Zepbound and Saxenda has been added back to the Preferred Drug List (PDL) as an off-cycle change.
medicaid.ncdhhs.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy (CV risk, MASH) and Zepbound (OSA) covered for FDA indications other than weight loss.
NC Medicaid continues to cover Wegovy and Zepbound for clinical indications other than weight loss based on the Food and Drug Administration (FDA)-approved indications and uses, which include:
medicaid.ncdhhs.gov, Sep 30, 2026 - Zepbound OSA indication listed.
Zepbound: Treatment of moderate to severe obstructive sleep apnea in adults with obesity.
medicaid.ncdhhs.gov, Sep 30, 2026
Type 2 diabetes
- The Oct. 2025 cut did not change GLP-1 coverage for diabetes (PDL status of Ozempic/Mounjaro not on these pages).
There will be no changes to coverage for GLP-1 medications for the treatment of diabetes.
medicaid.ncdhhs.gov, Sep 30, 2026
2 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
North DakotaDoes not cover them for weight loss
Program: North Dakota Health and Human Services, ND Medicaid. hhs.nd.gov
Based on a December 2023 provider newsletter; no later newsletter says otherwise.
Weight loss
- ND Medicaid provider newsletter (December 2023): from December 1, 2023, phentermine, bupropion, naltrexone and topiramate are covered for weight loss without prior authorization, and other medications are not covered for weight loss. No later newsletter through September 2026 changes this.
Effective Dec. 1, 2023, phentermine, bupropion, naltrexone and topiramate will be covered for weight loss with no prior authorization. Other medications are not covered for weight loss currently.
hhs.nd.gov, Sep 30, 2026
Changes
- ND HB 1451 (2025 bill; legislature text) would have added Medicaid coverage of anti-obesity medication.
A BILL for an Act to create and enact a new section to chapter 50-24.1 of the North Dakota Century Code, relating to medical assistance prescription drug benefits for antiobesity medication.
ndlegis.gov, Sep 30, 2026 - HB 1451 failed in the House on second reading, 12 to 81.
Second reading, failed to pass, yeas 12 nays 81
ndlegis.gov, Sep 30, 2026
Type 2 diabetes
- June 2024 provider newsletter: Ozempic, Rybelsus and Bydureon Bcise are covered after a trial of Victoza with 2 other diabetes drugs.
Ozempic, Rybelsus, and Bydureon Bcise are covered after a trial with Victoza with 2 other antihyperglycemic agents.
hhs.nd.gov, Sep 30, 2026 - ND Medicaid member news: from Jan 1, 2026 generic liraglutide needs PA; members may switch to Ozempic or Rybelsus.
As of January 1, 2026, a PA is required for generic liraglutide. If you use this product, you may have to switch to a similar medication, either Ozempic or Rybelsus.
hhs.nd.gov, Sep 30, 2026
5 more documents are PDFs, which we have not opened.
OhioDoes not cover them for weight loss
Program: Ohio Department of Medicaid. codes.ohio.gov
Weight loss
- Ohio Administrative Code 5160-9-03 (effective February 16, 2024): drugs for the treatment of obesity are non-covered by the Ohio Medicaid pharmacy program.
Drugs that fall into one of the following categories are non-covered by the Ohio medicaid pharmacy program: (1) Drugs for the treatment of obesity.
codes.ohio.gov, Sep 30, 2026
2 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
OklahomaDoes not cover them for weight loss
Program: Oklahoma Health Care Authority. oklahoma.gov
Weight loss
- OHCA rule: drugs used primarily for obesity are excluded from SoonerCare coverage.
Drugs used primarily for the treatment of obesity, such as appetite suppressants are not covered.
oklahoma.gov, Sep 30, 2026 - 2026 PA criteria (page last modified Sep 14, 2026): Wegovy only for CV risk reduction, not for obesity alone.
Wegovy® will not be approved for obese or overweight members in the absence of established CVD; and
oklahoma.gov, Sep 30, 2026 - Zepbound only for OSA, not for obesity alone.
Zepbound® will not be approved for obese members in the absence of OSA; and
oklahoma.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy covered with PA for CV risk reduction: age 45+, established CVD, BMI>=27, no diabetes.
Wegovy® (Semaglutide Injection and Tablets) Approval Criteria [Cardiovascular (CV) Risk Reduction Indication Only]:
oklahoma.gov, Sep 30, 2026 - CV criterion: age 45+.
Member must be 45 years of age or older; and
oklahoma.gov, Sep 30, 2026 - Zepbound covered with PA for moderate-to-severe OSA (AHI>=15, BMI>=30, no diabetes).
Zepbound® (Tirzepatide) Approval Criteria [Obstructive Sleep Apnea (OSA) Indication Only]:
oklahoma.gov, Sep 30, 2026
Type 2 diabetes
- Anti-diabetic tier table: Ozempic and Rybelsus are Tier 3; Mounjaro is in the “Special PA” column. Special PA requires a T2D diagnosis.
Glucagon-Like Peptide-1 (GLP-1) Agonists and Glucose-Dependent Insulinotropic Polypeptide (GIP)/GLP-1 Agonists Special PA Approval Criteria: An FDA approved diagnosis of type 2 diabetes mellitus; and
oklahoma.gov, Sep 30, 2026 SEMAGLUTIDE (OZEMPIC®) SEMAGLUTIDE (RYBELSUS®)
oklahoma.gov, Sep 30, 2026
1 more documents are PDFs, which we have not opened.
OregonDoes not cover them for weight loss
Program: Oregon Health Authority. orpdl.org
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Oregon Medicaid prior authorization criteria guide for fee-for-service Oregon Health Plan prescriptions (July 1, 2026, a PDF), Weight Management Drugs: drugs prescribed only for weight management (overweight or obesity) are not currently covered.
Note: Drugs prescribed for only weight management (overweight or obesity) are NOT currently covered
oregon.gov, Sep 29, 2026 Prior authorization (PA) criteria for fee-for-service prescriptions for Oregon Health Plan clients July 1, 2026
oregon.gov, Sep 29, 2026- Same section: semaglutide is not covered for adults without established cardiovascular disease, MASH or type 2 diabetes; tirzepatide is not covered for adults without obstructive sleep apnea or type 2 diabetes; liraglutide is not covered for adults without type 2 diabetes or MASH.
Note: Semaglutide is not currently covered for adults who do not have established cardiovascular disease, metabolic dysfunction-associated steatohepatitis (MASH), or type 2 diabetes. Tirzepatide is not currently covered for adults who do not have established obstructive sleep apnea or type 2 diabetes. Liraglutide is not covered for adults who do not have type 2 diabetes or MASH.
oregon.gov, Sep 29, 2026 - The same criteria are posted on orpdl.org; they list their implementation dates, the latest 3/1/26.
Implementation: 3/1/26; 5/12/25; 9/1/24; 7/1/24
orpdl.org, Sep 29, 2026
Criteria
- Members covered under the EPSDT program get case-by-case review.
Allow case-by-case review for members covered under the EPSDT program.
oregon.gov, Sep 29, 2026 - Oregon FFS PDL (orpdl.org, OHA’s PDL site) “Weight Management Drugs” class: Zepbound pen is preferred (Y) but requires pharmacy PA.
tirzepatide ZEPBOUND PEN INJCTR Y Pharmacy PA
orpdl.org, Sep 30, 2026 - Foundayo (orforglipron) is listed in the same class as non-preferred (N) with pharmacy PA.
orforglipron calcium FOUNDAYO TABLET N Pharmacy PA
orpdl.org, Sep 30, 2026
Changes
- Oregon HB 3517 (2025 bill; legislature text) would have required the Oregon Health Plan and other plans to cover certain obesity treatments.
Requires a policy or certificate of health insurance or health care services contract offered by a health care service contractor in this state, state medical assistance and health benefit plans offered by the Public Employees' Benefit Board and the Oregon Educators Benefit Board to cover certain treatments for an obesity diagnosis with certain requirements.
olis.oregonlegislature.gov, Sep 30, 2026 - The legislature’s site shows HB 3517 still in the House Committee on Behavioral Health and Health Care.
Current Location: In House Committee Current Committee: House Committee On Behavioral Health and Health Care
olis.oregonlegislature.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Covered uses in the same criteria: semaglutide for established cardiovascular disease (history of heart attack, stroke or symptomatic peripheral arterial disease; tablets or injection).
Semaglutide • Established cardiovascular disease (e.g., history of myocardial infarction, stroke, or symptomatic peripheral arterial disease) (tablets or injection)
oregon.gov, Sep 29, 2026 - Tirzepatide (Zepbound) for moderate to severe obstructive sleep apnea in adults with obesity.
Tirzepatide • Moderate to severe obstructive sleep apnea (OSA) in adults with obesity
oregon.gov, Sep 29, 2026
Type 2 diabetes
4 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
PennsylvaniaDoes not cover them for weight loss
Program: Pennsylvania Department of Human Services, Office of Medical Assistance Programs. pacodeandbulletin.gov
Weight loss
- Pennsylvania Bulletin notice (Pa.B. Doc. No. 25-1777, Dec 27, 2025): GLP-1s not covered for overweight/obesity from Jan 1, 2026.
Effective January 1, 2026, drugs containing a GLP-1 receptor agonist will not be covered for the treatment of overweight and obesity.
pacodeandbulletin.gov, Sep 30, 2026
Changes
- Coverage for obesity started Jan 2023 and was discontinued for dates of service on/after Jan 1, 2026.
The Department of Human Services (Department) announces the discontinuation of coverage of drugs containing a glucagon-like peptide-1 (GLP-1) receptor agonist for the treatment of overweight and obesity for Medical Assistance (MA) beneficiaries, effective for dates of service on and after January 1, 2026.
pacodeandbulletin.gov, Sep 30, 2026 - History: obesity coverage began January 2023.
The MA Program began covering drugs containing GLP-1s to treat overweight and obesity in January 2023, for MA beneficiaries who met the prior authorization guidelines.
pacodeandbulletin.gov, Sep 30, 2026 - Related provider bulletins (titles only on web page): 01-26-37 (Nov 2025), 01-26-41 and 01-26-49 (2026 PA revisions).
01-26-37 A Medical Assistance Bulletin entitled: Coverage Change and Prior Authorization of GLP-1 Receptor Agonists (Formerly Hypoglycemics, Incretin Mimetics/Enhancers and Obesity Treatment Agents) - Pharmacy Services
pa.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Notice lists OSA, MASH and CV risk reduction among FDA indications; these remain covered with PA (see t2d quote on “all other medically accepted indications”).
Drugs containing GLP-1s have been approved by the Federal Food and Drug Administration (FDA) to treat overweight, obesity, obstructive sleep apnea, noncirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced liver fibrosis and to reduce cardiovascular risk in patients who have had heart attack, stroke or other cardiovascular events.
pacodeandbulletin.gov, Sep 30, 2026
Type 2 diabetes
- GLP-1s for diabetes have been covered since 2005; all other indications remain covered with prior authorization.
GLP-1s are used to treat diabetes and have been covered by the MA Program since their introduction to the market in 2005.
pacodeandbulletin.gov, Sep 30, 2026 - PA required for all remaining indications.
Drugs containing a GLP-1 receptor agonist will continue to be covered for all other medically accepted indications with a prior authorization.
pacodeandbulletin.gov, Sep 30, 2026
What Medicaid health plans in Pennsylvania say
- Highmark Wholecare (Pennsylvania Medicaid plan) news item published Jan. 21, 2026 points providers to a Pennsylvania DHS bulletin about coverage and benefit changes for GLP-1s used for overweight/obesity for Medical Assistance beneficiaries; the page itself does not state what the change is.Highmark Inc.:
Highmark Wholecare encourages providers to review the Pennsylvania Department of Human Services Bulletin regarding coverage and benefit changes for glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of overweight and obesity for Medical Assistance beneficiaries.
providers.highmark.com, Sep 30, 2026
4 more documents are PDFs, which we have not opened.
Rhode IslandDoes not cover them for weight loss
Coverage for weight loss ends October 1, 2026, under the enacted state budget, per the agency's pharmacy page; we read it in a browser because the site blocks automated reading.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Rhode Island EOHHS pharmacy page, "GLP-1 State Budget Guidance": under the enacted state budget for fiscal year 2027, from October 1, 2026 Rhode Island Medicaid no longer covers certain GLP-1 receptor agonists prescribed solely for weight loss.
Pursuant to the Rhode Island State Fiscal Year 2027 Enacted Budget, beginning October 1, 2026,Rhode Island Medicaid will no longer cover certain GLP-1 receptor agonists when they are prescribed solely for weight loss.
eohhs.ri.gov, Sep 30, 2026 - The same notice says members getting these medicines for weight loss may no longer be able to obtain them through Medicaid from October 1, 2026.
Members receiving these medications for weight loss may be affected by this coverage change and may no longer be able to obtain them through Medicaid beginning October 1, 2026.
eohhs.ri.gov, Sep 30, 2026
Criteria
- Rhode Island Medicaid fee-for-service preferred drug list dated January 13, 2026 (a PDF), Weight Management Agents class: Wegovy is preferred; liraglutide, orlistat, phentermine/topiramate, Imcivree, Saxenda, Wegovy tablets, Xenical and Zepbound are non-preferred; the whole class needs clinical prior authorization.
Clinical Prior Authorization Required for Entire Class/Manual PA Preferred Non-Preferred PA Required Weight Management Agents Weight Management Agents NR Wegovy liraglutide orlistat capsule phentermine/topiramate Imcivree Saxenda Wegovy tabletsNR Xenical Zepbound
eohhs.ri.gov, Sep 29, 2026 Rhode Island Medicaid Fee for Service Preferred Drug List January 13, 2026
eohhs.ri.gov, Sep 29, 2026
Changes
- Senate Fiscal Office “First Look” at the Governor’s FY2027 budget (January 20, 2026, a PDF): the Governor recommended ending Medicaid coverage of GLP-1 medications except for type 2 diabetes, to save $6.3 million in general revenue ($20.3 million all funds).
Glucagon-like Peptide-1 (GPL-1) Coverage Removal: To realize $6.3 million in general revenue savings ($20.3 million all funds), the Governor recommends eliminating Medicaid coverage for GLP-1 medications, except if prescribed to treat type 2 diabetes.
rilegislature.gov, Sep 29, 2026 FIRST LOOK JANUARY 20, 2026
rilegislature.gov, Sep 29, 2026- Rhode Island FY2027 budget law (2026-H 7127 Sub A as amended, Article 8; legislature text, not the agency): authorizes the Medicaid agency to remove coverage of GLP-1 drugs except when prescribed for type 2 diabetes. The agency’s own notice and start date are on pages that blocked us.
(f) Glucagon-like Peptide-1 (GLP-1) Coverage. The secretary of the executive office of health and human services is authorized to pursue and implement any waiver amendments, state plan amendments, and/or changes to the applicable department's rules, regulations, and procedures required to remove coverage for GLP-1 medications, except if prescribed to treat type 2 diabetes.
webserver.rilegislature.gov, Sep 30, 2026 - The Legislative Press Bureau says the governor signed the 2027 budget bill (2026-H 7127Aaa) on June 12, 2026.
After passage by the General Assembly Tuesday, Gov. Daniel J. McKee today signed the 2027 state budget bill ( 2026-H 7127Aaa ), a balanced $15.2 billion plan
rilegislature.gov, Sep 30, 2026 - Article 8 of the budget says its Sections 8 and 9 (the GLP-1 subsection is in Section 8) take effect July 1, 2026.
SECTION 10. Sections 8 and 9 of this article shall take effect on July 1, 2026.
webserver.rilegislature.gov, Sep 30, 2026
What Medicaid health plans in Rhode Island say
- UHC’s Rhode Island Community Plan pharmacy page says that, under the state’s FY2027 budget, Rhode Island Medicaid will stop covering certain GLP-1s prescribed solely for weight loss beginning October 1, 2026.UnitedHealthcare:
Pursuant to the Rhode Island State Fiscal Year 2027 Enacted Budget, beginning October 1, 2026, Rhode Island Medicaid will no longer cover certain GLP-1 receptor agonists when they are prescribed solely for weight loss.
uhcprovider.com, Sep 30, 2026
5 more documents are PDFs, which we have not opened. 4 of the state's pages blocked automated reading.
South CarolinaDoes not cover them for weight loss
Program: South Carolina Department of Health and Human Services. scdhhs.gov
Based on an actuarial report Milliman wrote for the state (June 19, 2026), not a notice from the Medicaid agency.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026 and Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Milliman’s SFY 2027 Medicaid managed care capitation rate certification for SCDHHS (June 19, 2026, a PDF on scdhhs.gov): effective January 1, 2026, SCDHHS ended coverage of GLP-1s for weight management; Wegovy was the main drug used under that benefit.
Effective January 1, 2026, SCDHHS terminated coverage of GLP-1s for weight management. Wegovy was the primary treatment utilized for this benefit and totaled approximately $6.1 million in the SFY 2025 base data period.
scdhhs.gov, Sep 29, 2026 MILLIMAN REPORT SFY 2027 Medicaid Managed Care Capitation Rate Certification South Carolina Department of Health and Human Services June 19, 2026
scdhhs.gov, Sep 29, 2026
Sleep apnea, heart risk, MASH
- The same report expects more use for covered indications such as cardiovascular risk and MASH after the change.
Based on emerging experience after the benefit change and consideration for an increase in utilization related to covered indications such as cardiovascular and metabolic-associated steatohepatitis (MASH), an adjustment is being applied to the pharmacy category of service.
scdhhs.gov, Sep 29, 2026
Type 2 diabetes
- South Carolina Medicaid GLP-1 criteria (revised 05/01/2026): for adults, Ozempic, Trulicity and Victoza are approved for diabetes with a documented type 2 diabetes diagnosis (plus a metformin trial and a recent A1c).
Trulicity® (dulaglutide), Victoza® (liraglutide), Ozempic® (semaglutide) for Diabetes Age ≥ 18 years; AND Documented diagnosis of T2DM; AND
southcarolina.fhsc.com, Sep 28, 2026 - Other products listed in the same criteria, including Mounjaro, also need a trial of the preferred products (Ozempic, Trulicity, Victoza) or a reason they cannot be used.
Must also have a trial or failure of preferred products (Ozempic®, Trulicity®, and Victoza®), or rationale as to why the preferred products cannot be used.
southcarolina.fhsc.com, Sep 28, 2026 - The PBM portal (Prime Therapeutics, SCDHHS contractor) lists a PA criteria document for GLP-1 / GLP-1/GIP receptor agonists.
GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists
southcarolina.fhsc.com, Sep 30, 2026
2 more documents are PDFs, which we have not opened.
South DakotaDoes not cover them for weight loss
Program: South Dakota Department of Social Services, Division of Medical Services. dss.sd.gov
Based on the drug list on Optum Rx's site, which the state links to, not a state page.
Weight loss
- South Dakota Medicaid drug list (PDL 2026 tab on the Optum Rx South Dakota Medicaid pharmacy website, linked from the state’s pharmacy page): the GLP-1 class is marked “No coverage for weight loss”.
ANTIDIABETICS GLP-1 RECEPTOR AGONISTS **No coverage for weight loss
sdm.pharmacy.optum.com, Sep 30, 2026
Sleep apnea, heart risk, MASH
- The same 2026 list allows Wegovy only for heart risk (MACE) or MASH, and Zepbound only for sleep apnea (OSA).
WEGOVY (MACE or MASH only) ZEPBOUND (OSA only)
sdm.pharmacy.optum.com, Sep 30, 2026
Type 2 diabetes
- The 2026 GLP-1 class lists Mounjaro, Ozempic, Rybelsus, Trulicity and Victoza as preferred.
MOUNJARO OZEMPIC RYBELSUS TRULICITY VICTOZA WEGOVY (MACE or MASH only)
sdm.pharmacy.optum.com, Sep 30, 2026
5 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
TennesseeCovers GLP-1s for weight loss
Program: Division of TennCare. contenthub-aem.optumrx.com
Based on interim criteria from August 2025; later updates are published as PDFs.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- TennCare pharmacy notice (dated 08/01/25): from August 1, 2025, medicines for obesity management are covered for adults (21 and over) and children, per the drug label, with interim prior authorization (PA) criteria and quantity limits.
Effective August 1, 2025, medications for obesity management will be covered for both adults (ages 21 and over) and children per medication label subject to interim prior authorization (PA) criteria and quantity limits.
contenthub-aem.optumrx.com, Sep 28, 2026 - Wegovy and Zepbound are preferred drugs that need prior authorization (PA) and have quantity limits (QL).
The following will be considered preferred with PA: WEGOVY PA, QL, ZEPBOUND PA, QL.
contenthub-aem.optumrx.com, Sep 28, 2026 - Saxenda is non-preferred (PA and quantity limit).
The following will be considered non-preferred: EVEKEO PA, QL, IMCIVREE PA, QL, SAXENDA PA, QL.
contenthub-aem.optumrx.com, Sep 28, 2026
Criteria
- Interim criteria for adults (as written for Wegovy and Saxenda): medical records showing a BMI of 30 or more, or a BMI of 27 or more with a weight-related condition such as high blood pressure, abnormal cholesterol, diabetes, heart disease, MASH or sleep apnea.
Submission of medical records (e.g. chart notes) documenting a body mass index (BMI) of greater than or equal to 30 kg/m2; OR Submission of medical records (e.g. chart notes) documenting a BMI of greater than or equal to 27 kg/m2 with a weight related comorbidity (e.g. hypertension, dyslipidemia, diabetes, coronary heart disease, MASH/NASH, obstructive sleep apnea); AND
contenthub-aem.optumrx.com, Sep 28, 2026 - The prescriber must confirm the patient is also making diet and lifestyle changes.
Prescriber attests patient is participating in complementary nutritional and lifestyle changes (e.g. dietary modification, increased physical activity as medically able, structured behavioral intervention, comprehensive weight management program); AND
contenthub-aem.optumrx.com, Sep 28, 2026 - Renewal needs records showing a loss of at least 5% of starting body weight.
Submission of medical records (e.g. chart notes) documenting a weight loss of ≥ 5% of baseline body weight
contenthub-aem.optumrx.com, Sep 28, 2026 - Zepbound: the patient must be at least 18 (its labeled minimum age).
Patient must be the labeled age minimum (Zepbound ≥ 18); AND
contenthub-aem.optumrx.com, Sep 28, 2026
Changes
- TennCare’s pharmacy portal (OptumRx) also lists a later notice, “Weight Management Updates” dated 12.01.25 (a PDF we have not opened).
Provider Notice Weight Management Updates 12.01.25
welcome.optumrx.com, Sep 30, 2026
3 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
TexasNot confirmed in the state's own pages
Program: Texas Health and Human Services Commission. tmhp.com
Weight loss
- Not a GLP-1: a TMHP notice (August 26, 2022) says Texas Medicaid covers Xenical (orlistat) for obesity management and dropped its prior authorization from September 12, 2022. It says nothing about GLP-1s.
HHSC will no longer require prior authorization for Xenical (Orlistat) because Medicaid covers the drug for the indication of obesity management, and the drug is not dependent on a hyperlipidemia condition.
tmhp.com, Sep 30, 2026
Changes
- Texas HB 2677 (2025 bill; legislature text) was about Medicaid coverage of obesity treatment.
Relating to Medicaid coverage and reimbursement for the treatment of obesity and certain diabetes prevention program services.
capitol.texas.gov, Sep 30, 2026 - HB 2677’s last recorded action: placed on the House General State Calendar on 05/14/2025; it did not pass that session.
Last Action: 05/14/2025 H Placed on General State Calendar
capitol.texas.gov, Sep 30, 2026 - The Legislative Budget Board fiscal note for HB 2677 assumed anti-obesity medication would be made available in Medicaid from fiscal year 2027 if the bill passed.
This analysis assumes anti-obesity medication would be made available on a non-risk basis beginning in fiscal year 2027, before being carved into managed care in fiscal year 2030.
capitol.texas.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy MASH indication covered with clinical PA from Nov 24, 2025 (TMHP news). CV/OSA criteria are in VDP PDF guides.
Beginning November 24, 2025, Texas Medicaid and managed care organizations (MCOs) will require providers to get clinical prior authorization for the Wegovy MASH indication for clients who are enrolled in Medicaid fee-for-service.
tmhp.com, Sep 30, 2026 - Zepbound has a clinical PA criteria guide (indication not stated on this page; updated Nov 24, 2025).
Texas Medicaid and managed care organizations (MCOs) will implement the updated clinical prior authorization requirements for Zepbound on November 24, 2025.
tmhp.com, Sep 30, 2026
7 of the state's pages blocked automated reading.
UtahDoes not cover them for weight loss
Program: Utah Department of Health and Human Services. medicaid.utah.gov
Based on a prior authorization form last updated June 1, 2026, which says weight-loss coverage is a pilot that may not continue past June 30, 2026 and only renews earlier approvals until then.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Utah Medicaid prior authorization form “GLP-1 Medications for Weight-related Comorbidities” (Saxenda, Wegovy, Zepbound; last updated 6-1-26, a PDF): approvals for obesity (Saxenda, Zepbound, Wegovy) are reauthorizations that run up to and no later than 6/30/2026.
Obesity (Saxenda/Zepbound/Wegovy): Up to and no later than 6/30/2026* for reauthorizations
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 - The form says weight-loss coverage is part of a pilot program that may not continue past 6/30/2026.
* Coverage for weight-loss is part of a pilot program and may not continue past 6/30/2026
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 - On the form, requests for Saxenda, Wegovy or Zepbound for obesity outside the heart, sleep apnea and MASH categories go to the reauthorization part.
Saxenda, Wegovy, or Zepbound, for patients with obesity who do not otherwise fit the categories above (Continue to reauthorization PART 8)
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 - An obesity-only request needs an active weight-loss prior authorization approved between 7/1/2025 and 6/30/2026.
Does the patient have active prior authorization approved for weight loss between 7/1/2025 - 6/30/2026?
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 GLP-1 Medications for Weight-Related Comorbidities 1 of 4 Last Updated 6-1-26
medicaid-documents.dhhs.utah.gov, Sep 29, 2026- The FFS pharmacy PA forms page still lists that form with the date 06/19/2026 (checked 2026-09-29).
GLP-1 Medications for Weight-related Comorbidities.pdf File 06/19/2026
medicaid.utah.gov, Sep 30, 2026
Changes
- Utah legislature budget data (2025 request SAR0087; legislature text, not the agency): the request was to cover anti-obesity medications for some Medicaid members with a BMI over 30 and other health risks; the Legislature gave a smaller one-time amount. It does not say when or how coverage ran.
This request is to cover AOM's for certain Medicaid members with a BMI over 30% and other associated health risks. Covering this group will cost approximately $1.4 million in total funds with $298,200 of that amount coming from state funds. The Legislature provided a smaller one-time amount.
cobi-ws.utah.gov, Sep 30, 2026 - A 2026 request (SAR0106, “Access to Anti-obesity Medication Cost Savings in Medicaid”) repeats the same purpose.
This request is to cover AOMs for certain Medicaid members with a BMI over 30% and other associated health risks.
cobi-ws.utah.gov, Sep 30, 2026 - The budget data links the 2026 request to 2026 H.B. 3, Item 453.
Appropriations: HB0003 - Item: 453
cobi-ws.utah.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- The same form still allows Wegovy for patients 18 or older with a history of a major cardiovascular event (MACE).
Wegovy, for 18+ year old patients with a history of a Major Cardiovascular Adverse Event (MACE)
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 - Zepbound for patients 18 or older with confirmed moderate to severe obstructive sleep apnea.
Zepbound, for a 18+ year old patient with a confirmed diagnosis of Moderate to Severe Obstructive Sleep Apnea (OSA)
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 - Wegovy for patients 18 or older with confirmed MASH.
Wegovy, for 18+ year old patients with a confirmed diagnosis of Metabolic Dysfunction Associated Steatohepatitis (MASH)
medicaid-documents.dhhs.utah.gov, Sep 29, 2026
Type 2 diabetes
- Utah Medicaid fee-for-service PDL effective September 1, 2026 (a PDF): GLP-1 agonists are only covered for type 2 diabetes.
GLP-1 Agonists are only covered for type 2 diabetes mellitus.
medicaid-documents.dhhs.utah.gov, Sep 29, 2026 Utah Medicaid Fee-for-Service Preferred Drug List (PDL) & Pharmacy Coverage Resources Effective September 1, 2026
medicaid-documents.dhhs.utah.gov, Sep 29, 2026- Mounjaro and Ozempic injection are preferred brands in that class.
Mounjaro Preferred Brand 09/01/26 2ml per 28 days, min age of 10 years old Ozempic inj Preferred Brand 01/01/26 3ml per 28 days, min age of 18 years old
medicaid-documents.dhhs.utah.gov, Sep 29, 2026
4 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
VermontDoes not cover them for weight loss
Program: Department of Vermont Health Access. dvha.vermont.gov
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Vermont preferred drug list (effective version updated 8/1/2026, a PDF): drugs used for weight loss are excluded from coverage under the Vermont Medicaid Pharmacy program.
Drugs used for weight loss, drugs used to promote fertility, and drugs used for cosmetic purposes or hair growth are excluded from coverage under the Vermont Medicaid Pharmacy program.
dvha.vermont.gov, Sep 29, 2026 Effective Version Updated: 8/1/2026
dvha.vermont.gov, Sep 29, 2026- DVHA’s semaglutide prior authorization form for heart risk (MACE) and MASH (last updated 04/2026, a PDF): per policy, Vermont Medicaid does not allow coverage for weight loss products.
(Per policy Vermont Medicaid does not allow coverage for weight loss products)
dvha.vermont.gov, Sep 29, 2026 Last Updated: 04/2026
dvha.vermont.gov, Sep 29, 2026
Changes
- Vermont H.765 (2024), a bill on health insurance coverage for obesity care, was read the first time and referred to the House Committee on Health Care on 1/11/2024.
1/11/2024 - Read first time and referred to the Committee on Health Care
legislature.vermont.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- PDL criteria for Wegovy (Cardiometabolic Health Agents): it must not be used for weight loss only, and the patient must not have diabetes.
Wegovy: • Medication is not being used for weight loss only • Patient does not have diagnosis of diabetes
dvha.vermont.gov, Sep 29, 2026 - Wegovy for heart risk (MACE): BMI over 27 and a history of stroke, heart attack or symptomatic peripheral arterial disease.
Indication for use is Major Adverse Cardiac Event (MACE) Reduction: o Patient has BMI > 27 kg/m2 o Patient has history of at least one of the following: ▪ Stroke ▪ Myocardial Infarction ▪ Symptomatic peripheral arterial disease
dvha.vermont.gov, Sep 29, 2026 - Zepbound for obstructive sleep apnea: a sleep study with an AHI over 15 and a BMI over 30.
Zepbound: Patient has a diagnosis of obstructive sleep apnea (OSA) demonstrated by a sleep study with an AHI (events per hour) > 15 and meets the following criteria: • BMI > 30 kg/m2
dvha.vermont.gov, Sep 29, 2026 - DVHA posts a PA form for semaglutide (Wegovy) for MACE reduction / MASH.
Semaglutide: Major Cardiovascular Event (MACE) Reduction/ MASH
dvha.vermont.gov, Sep 30, 2026 - DVHA posts a PA form for Zepbound for obstructive sleep apnea.
Zepbound: Obstructive Sleep Apnea
dvha.vermont.gov, Sep 30, 2026
7 more documents are PDFs, which we have not opened.
VirginiaCovers them only in narrow cases
Program: Virginia Department of Medical Assistance Services. vamedicaid.dmas.virginia.gov
Based on a June 2023 bulletin, the latest criteria on a web page; later changes are in PDFs and budget text.
Weight loss
- DMAS bulletin (June 23, 2023; latest web-verifiable criteria found) sets service-authorization criteria for GLP-1 weight-loss drugs for FFS and MCO members; so covered under strict criteria. Later changes (Aug 2024 BMI criteria; 2026 budget language) are only in PDFs/budget text.
Requirement that patients have a BMI of at least 40 kg/m2, or a BMI of at least 35 kg/m2 and two or more chronic conditions, for approval of GLP-1 drugs
vamedicaid.dmas.virginia.gov, Sep 30, 2026 - Applies to FFS and MCO members.
These changes will ensure appropriate access to and use of approved weight loss pharmacotherapies for FFS and MCO members to support long term health outcomes and ensure alignment with requirements outlined in 12 VAC 30-50-210 (A)(3).
vamedicaid.dmas.virginia.gov, Sep 30, 2026
Criteria
- 2023 criteria also require trial/failure of a non-GLP-1 weight-loss drug in prior 6 months.
Requirement that patients try and fail a non-GLP-1 weight loss drug in the previous 6 month before approval of GLP-1 drugs
vamedicaid.dmas.virginia.gov, Sep 30, 2026 - 2023 criteria require attestation that obesity is disabling and life-threatening.
Requirement that providers attest to the patient’s obesity as disability and life threatening (i.e. puts the patient at risk for high morbidity conditions)
vamedicaid.dmas.virginia.gov, Sep 30, 2026
3 more documents are PDFs, which we have not opened. 2 of the state's pages blocked automated reading.
WashingtonDoes not cover them for weight loss
Program: Washington State Health Care Authority. hca.wa.gov
Weight loss
- WAC 182-530-2100 (last amended by WSR 25-21-142, effective 11/21/25): Apple Health does not cover drugs prescribed for weight loss.
(b) A drug prescribed: (i) For weight loss or gain;
app.leg.wa.gov, Sep 30, 2026 (1) The medicaid agency does not cover:
app.leg.wa.gov, Sep 30, 2026
Changes
- Rule history: most recent amendment effective 11/21/25 (weight-loss exclusion retained).
WSR 25-21-142, s 182-530-2100, filed 10/21/25, effective 11/21/25;
app.leg.wa.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- HCA lists separate anti-obesity-class GLP-1 policies for semaglutide (61.25.20.AA) and tirzepatide (61.25.25.AA).
Anorexiants/Anti-Obesity GLP-1 Receptor Agonists - semaglutide GLP-1 Receptor Agonists - tirzepatide 61.25.20.AA 61.25.25.AA
hca.wa.gov, Sep 30, 2026
Type 2 diabetes
- HCA drug coverage criteria list includes an “Antidiabetics: GLP-1 agonists” policy (content PDF).
Antidiabetics Amylin analogs GLP-1 agonists
hca.wa.gov, Sep 30, 2026
2 more documents are PDFs, which we have not opened.
West VirginiaDoes not cover them for weight loss
Program: West Virginia Department of Human Services, Bureau for Medical Services. bms.wv.gov
Based on the Zepbound criteria effective July 1, 2025, which say weight-loss drugs are “typically” not covered.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- West Virginia Bureau for Medical Services prior authorization criteria for Zepbound (effective 7/1/2025, a PDF): agents used for weight loss are “typically a benefit exclusion and not covered” by West Virginia Medicaid, and Zepbound is considered only for sleep apnea (OSA) in adults with obesity.
Agents used for the purpose of weight loss are typically a benefit exclusion and not covered by West Virginia Medicaid. Coverage of Zepbound will only be considered for a diagnosis of OSA in adults with obesity.
bms.wv.gov, Sep 29, 2026 Office of Pharmacy Services Prior Authorization Criteria Zepbound® (tirzepatide) Effective 7/1/2025
bms.wv.gov, Sep 29, 2026
Changes
- West Virginia S.B. 743 (2024), on a Medicaid medically supervised weight loss program, was last referred to Senate Finance on 02/21/24.
Senate Bill 743 Legislative Session: 2024(RS) LAST ACTION: S Referred to Finance on 2nd reading 02/21/24 SUMMARY: Relating to Bureau for Medical Services’ medically supervised weight loss program
wvlegislature.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Zepbound for OSA needs moderate to severe sleep apnea confirmed by a sleep study in the past 12 months (AHI of 15 or more).
The patient has a diagnosis of moderate to severe OSA with a sleep study within the past twelve months confirming an apnea-hypopnea index (AHI) greater than or equal to fifteen events per hour; AND
bms.wv.gov, Sep 29, 2026 - It also needs a documented BMI of 30 or more within the past three months.
The patient has a diagnosis of obesity with a documented Body Mass Index (BMI) of 30 kg/m² or greater within the past three months
bms.wv.gov, Sep 29, 2026 - BMS lists Wegovy and Zepbound among point-of-sale/PDL agents with PA criteria.
Wegovy
bms.wv.gov, Sep 30, 2026
4 more documents are PDFs, which we have not opened.
WisconsinCovers GLP-1s for weight loss
Program: Wisconsin Department of Health Services, ForwardHealth. forwardhealth.wi.gov
From the drug list effective October 1, 2026; the prior authorization criteria come from the ForwardHealth handbook.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 28, 2026. Our weekly check does not re-download files.
Weight loss
- ForwardHealth preferred drug list quick reference (effective October 1, 2026): Foundayo and Zepbound are preferred Weight Management Agents; prior authorization is required for all drugs in the class.
Weight Management Agents Foundayo P Zepbound P Note: Prior Authorization is required for all drugs in this class.
forwardhealth.wi.gov, Sep 28, 2026 - ForwardHealth Online Handbook (printed 09/27/2026), Wegovy topic #24323: Wegovy injection is approved only for MACE, MASH, and weight loss in pediatric patients 12–17; adult weight loss is not a listed condition.
PA requests for Wegovy injection will only be approved for use in the identified clinical conditions: To reduce the risk of MACE in overweight or obese adults with established cardiovascular disease To treat MASH in adults To reduce excess body weight and maintain weight reduction long term in pediatric patients aged 12–17 years old with obesity
forwardhealth.wi.gov, Sep 30, 2026 - A “Weight Management Agents” PDL drug class exists (topic #24303) with PA for all agents; the handbook page does not name which drugs are in the class (the PDL Quick Reference PDF does).
PA is required for all weight management agents, including preferred weight management agents. Weight management agents that are not included in this PDL drug class or do not have separate established clinical criteria are noncovered services.
forwardhealth.wi.gov, Sep 30, 2026
Criteria
- Weight Management Agents PA: BMI >=30, or BMI 27–<30 with two or more listed risk factors; plus diet/activity agreement; initial approval up to 183 days.
The member has a BMI greater than or equal to 30. The member has a BMI greater than or equal to 27 but less than 30 and has two or more of the following risk factors:
forwardhealth.wi.gov, Sep 30, 2026 - Renewal requires BMI reduction from baseline; up to 365 days.
Renewal PA requests require the member to have a reduction in BMI compared to their baseline prior to the initiation of the weight management agent. Renewal PA requests for weight management agents may be approved for up to 365 days.
forwardhealth.wi.gov, Sep 30, 2026 - Pediatric Wegovy criteria: age 12–17 and BMI >= 95th percentile.
The member is 12–17 years of age. The member has a BMI greater than or equal to the 95th percentile standardized by age and gender.
forwardhealth.wi.gov, Sep 30, 2026
Sleep apnea, heart risk, MASH
- Wegovy for MACE: established CVD (prior MI, stroke, or PAD) and BMI >=27; initial PA up to 183 days.
PA requests for Wegovy tablets will only be approved to reduce the risk of MACE in overweight or obese adults with established cardiovascular disease.
forwardhealth.wi.gov, Sep 30, 2026 - CV criterion BMI>=27.
The member has a BMI greater than or equal to 27.
forwardhealth.wi.gov, Sep 30, 2026
Type 2 diabetes
- GLP-1s for diabetes are in the “hypoglycemics, GLP-1” PDL class and are diagnosis-restricted (allowed diagnosis code on claim or PA). Specific preferred agents are listed only in the PDF Quick Reference.
All drugs in the hypoglycemics, GLP-1 drug class are diagnosis restricted. A ForwardHealth-allowed diagnosis code must be indicated on claims (and PA requests when applicable) for all drugs in the hypoglycemics, GLP-1 drug class.
forwardhealth.wi.gov, Sep 30, 2026 - Non-preferred hypoglycemics GLP-1 PA requires type 2 diabetes.
The member has type 2 diabetes mellitus.
forwardhealth.wi.gov, Sep 30, 2026
2 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
WyomingDoes not cover them for weight loss
Program: Wyoming Department of Health, Wyoming Medicaid pharmacy program. health.wyo.gov
Based on a clinical criteria chart (June 8, 2026) that allows Wegovy only with heart disease and Zepbound only with sleep apnea; it does not say in words that weight loss is excluded.
Some lines below come from an official document file (PDF, Word, Excel or RTF) read on Sep 29, 2026. Our weekly check does not re-download files.
Weight loss
- Wyoming Medicaid “Additional Therapeutic Classes with Clinical Criteria” chart (last updated June 8, 2026, a PDF): Wegovy requires cardiovascular disease; the client must have a BMI of 27 or higher with a prior heart attack, prior stroke or peripheral artery disease.
WEGOVY Client must have BMI of 27 or higher with cardiovascular disease defined as prior myocardial infarction, prior stroke, or peripheral artery disease.
wymedicaid.org, Sep 29, 2026 - Same chart: Zepbound requires a diagnosis of moderate to severe obstructive sleep apnea; it is approved for obese adults with an AHI over 15 on a sleep study in the prior 12 months.
ZEPBOUND Client must have diagnosis of moderate to severe obstructive sleep apnea. Will be approved for obese adults with an AHI (Apnea-Hypopnea Index) of greater than 15 as evidenced by sleep study within the prior 12 months.
wymedicaid.org, Sep 29, 2026 WYOMING MEDICAID ADDITIONAL THERAPEUTIC CLASSES WITH CLINICAL CRITERIA Last Updated June 8, 2026
wymedicaid.org, Sep 29, 2026- The September 1, 2025 version of the chart has the same Wegovy line.
WEGOVY Client must have BMI of 27 or higher with cardiovascular disease defined as prior myocardial infarction, prior stroke, or peripheral artery disease.
wymedicaid.org, Sep 29, 2026
6 more documents are PDFs, which we have not opened. 1 of the state's pages blocked automated reading.
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