20 of 51 states cover Wegovy or Zepbound on Medicaid

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity no. Medi-Cal Rx stopped covering Saxenda, Wegovy and Zepbound for weight loss on January 1, 2026. Wegovy prior approval requests are reviewed case by case for cardiovascular disease and for non-cirrhotic MASH liver disease. Zepbound is reviewed case by case for obstructive sleep apnea. Medi-Cal Rx reviews requests for members under 21 under EPSDT, the federal coverage requirement for that age group. Important Update: GLP-1s for Weight Loss Are Not a Covered Benefit, effective 2026-01-01. Checked 2026-09-04.

Who sets the rule: DHCS transitioned all Medi-Cal pharmacy services from managed care to fee-for-service. The carve-out, where the state runs the drug benefit instead of the plan, took effect January 1, 2022. The four plans listed do not run this benefit.

If you are not in a plan: type 2 diabetes yes with prior approval. The state GLP-1 criteria require a type 2 diabetes diagnosis and an HbA1c test in the last 180 days, and deny for end-stage renal disease, medullary thyroid carcinoma or MEN 2, an inherited endocrine cancer syndrome. Obesity alone no. Wegovy is approved with prior approval at age 45 or over with a cardiovascular disease diagnosis plus a diagnosis of obesity or overweight, or at 18 or over for non-cirrhotic MASH liver disease with stage F2 to F3 fibrosis. Zepbound is approved with prior approval for moderate to severe obstructive sleep apnea with an apnea-hypopnea index of at least 15 plus a diagnosis of obesity. Texas Prior Authorization Program Clinical Criteria: Hypoglycemics Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, effective 2026-04-24. Checked 2026-09-04.

Who sets the rule: Texas HHSC requires Medicaid managed care plans to follow the state preferred drug list, and lists the Wegovy and Zepbound clinical prior approvals as required for managed care plans. The GLP-1 receptor agonist clinical prior approval is optional for managed care plans.

If you are not in a plan: type 2 diabetes yes with clinical prior approval. The state GLP-1 criteria require a type 2 diabetes diagnosis, an HbA1c of 6.5 percent or higher measured within the past six months, and a documented try of metformin that did not work within the past two years. Preferred agents are Mounjaro, Ozempic and Trulicity; exenatide, liraglutide, Rybelsus and Victoza are non-preferred. Wegovy, Zepbound and Saxenda do not appear on the state preferred drug list and Florida's GLP-1 criteria document covers only type 2 diabetes. Glucagon-like Peptide-1 (GLP-1) Receptor Agonists and Dual glucose-dependent insulinotropic polypeptide (GIP) receptor/GLP-1 Receptor Agonists, Prior Authorization Criteria, effective 2026-03-12. Checked 2026-09-04.

Who sets the rule: Florida's managed care plans use the AHCA statewide preferred drug list. Sunshine Health points members to the AHCA preferred drug list as the list of covered medicines, and Humana Healthy Horizons states that the AHCA preferred drug list includes the same information as its own preferred drug list.

If you are not in a plan: type 2 diabetes yes with prior approval. Preferred GLP-1s are exenatide, Ozempic pen, Trulicity and Victoza; liraglutide, Mounjaro, Rybelsus (the semaglutide tablet), Soliqua and Xultophy are non-preferred. Obesity alone no. Wegovy requires a confirmed cardiovascular disease diagnosis, a BMI of 40 or higher and participation in lifestyle changes, and carries a lifetime limit of two treatment attempts. Zepbound requires an obstructive sleep apnea diagnosis, a BMI of 40 or higher and lifestyle changes, with the same lifetime limit of two treatment attempts. NYRx, the Medicaid Pharmacy Program Preferred Drug List, effective 2026-07-16. Checked 2026-09-04.

Who sets the rule: As of April 1, 2023 all Medicaid members enrolled in Mainstream Managed Care receive their prescription drugs through NYRx. The four plans listed do not run this benefit.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity no. Coverage for drugs containing a GLP-1 receptor agonist for the treatment of overweight and obesity ended January 1, 2026. GLP-1s remain covered for all other medically accepted indications with prior approval, including moderate to severe obstructive sleep apnea, reduction in risk of major adverse cardiovascular events, and MASH liver disease with moderate to advanced fibrosis. Saxenda is no longer covered for any indication. Non-GLP-1 obesity treatment agents on the Statewide preferred drug list stay covered. Medical Assistance Bulletin: Coverage Change and Prior Authorization of GLP-1 Receptor Agonists (Formerly Hypoglycemics, Incretin Mimetics/Enhancers and Obesity Treatment Agents), Pharmacy Services, effective 2026-01-01. Checked 2026-09-04.

Who sets the rule: The bulletin states that the guidelines to determine the medical necessity of GLP-1 receptor agonists will be used in the fee-for-service and managed care delivery systems.

If you are not in a plan: type 2 diabetes yes with prior approval. In the GLP-1 medicines class the preferred drug list lists Trulicity, Victoza and the Ozempic pen as preferred, and Rybelsus (the semaglutide tablet) and Mounjaro as non-preferred. Obesity no. Wegovy, Zepbound and Saxenda do not appear on the state preferred drug list, and 89 Ill. Adm. Code 140.441(b) excludes appetite suppressants from coverage. Illinois publishes no GLP-1 cardiovascular criteria. Illinois Medicaid Preferred Drug List Effective July 27, 2026, effective 2026-07-27. Checked 2026-09-04.

Who sets the rule: The Illinois Medicaid mandated preferred drug list took effect January 1, 2020. All managed care Medicaid health plans must cover the same medications as the Illinois fee-for-service plan.

If you are not in a plan: type 2 diabetes yes with prior approval. Since December 8, 2025, claims for preferred GLP-1 receptor agonists require a documented diagnosis of type 2 diabetes, and Ohio Medicaid states that coverage is not available for other non-FDA-approved uses such as prediabetes or weight loss. Obesity no. Wegovy is covered with prior approval for major adverse cardiovascular event risk reduction at age 18 or over with a BMI of 27 or higher and a history of prior myocardial infarction, prior stroke or symptomatic peripheral artery disease, and separately for non-cirrhotic MASH liver disease with stage F2 to F3 fibrosis. Wegovy follows a different rule from the preferred diabetes GLP-1s: Ohio denies it for anyone with type 1 or type 2 diabetes. Ohio Medicaid Pharmacy Benefit Management Program Unified Preferred Drug List, Medicaid Fee-for-Service and Managed Care Plans, effective 2026-04-01. Checked 2026-09-04.

Who sets the rule: The Ohio Unified Preferred Drug List states on its cover that it applies to Medicaid fee-for-service and managed care plans. Pharmacy for all Ohio Medicaid managed care runs through the single pharmacy benefit manager.

If you are not in a plan: type 2 diabetes yes with prior approval. In the GLP-1 medicines class the state preferred drug list lists the liraglutide pen and Ozempic as preferred. Obesity no: Georgia's Medicaid state plan excludes drugs used to change weight, which the statute lists as agents for anorexia, weight loss or weight gain, and Wegovy, Zepbound and Saxenda do not appear on the state preferred drug list. Georgia publishes no GLP-1 cardiovascular criteria. Georgia State Plan Amendment GA-24-0001, approved June 6, 2024, effective 2024-01-01. Checked 2026-09-04.

Who sets the rule: Georgia publishes one Medicaid-approved preferred drug list. Georgia's Medicaid state plan excludes agents used for anorexia, weight loss or weight gain.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity yes with prior approval. NC Medicaid ended weight-management coverage on October 1, 2025 and reinstated it effective December 12, 2025 under the criteria in place on September 30, 2025. Adults need a BMI of 30 or higher, or 27 or higher with at least one weight-related comorbidity, a documented baseline weight and BMI within 45 days, and a lifestyle plan. Wegovy is preferred; Zepbound and Saxenda are non-preferred and need a trial of Wegovy first. Wegovy is also covered for cardioprotection at age 45 or over with a baseline BMI above 27 and established cardiovascular disease. Zepbound is covered for moderate to severe obstructive sleep apnea and Wegovy for MASH liver disease with moderate to advanced fibrosis. NC Medicaid Outpatient Pharmacy Prior Approval Criteria: GLP1s for Weight Management, Wegovy and Zepbound, effective 2024-08-01. Checked 2026-09-04.

Who sets the rule: The reinstatement bulletin states that it applies to NC Medicaid Direct and NC Medicaid Managed Care.

If you are not in a plan: type 2 diabetes yes with prior approval, unchanged. Obesity yes on one narrow route since January 1, 2026. To be approved for obesity alone the patient must be classified as morbidly obese, must have documented failure of all other clinically appropriate weight-loss interventions including a documented try of the preferred anti-obesity agents on the Single preferred drug list, and the drug must be used only as a measure to avert the need for bariatric surgery. Coverage for indications other than obesity did not change. Saxenda and Wegovy became non-preferred on the Single preferred drug list for their other covered indications, with a $3 copayment. Update of Pharmacy Drug Coverage for Treatment of Obesity, reproducing the MDHHS provider L-letter L 25-73, effective 2026-01-01. Checked 2026-09-04.

Who sets the rule: The MDHHS provider L-letter was distributed December 8, 2025 to all Michigan Medicaid providers and pharmacies. Michigan runs a Single Preferred Drug List and a Common Formulary for Medicaid health plans.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity no for adults. The Department of Human Services states that NJ FamilyCare covers drugs indicated for weight loss only in limited circumstances, namely when a GLP-1 is prescribed for an FDA-approved indication other than weight loss, and where required under EPSDT, the federal coverage requirement for members under 21. Wegovy is covered when clinically appropriate for cardiovascular disease and Zepbound is covered for sleep apnea. NJ FamilyCare Coverage of Weight Loss Drugs. Checked 2026-09-04.

Who sets the rule: New Jersey Medicaid managed care plans run their own pharmacy benefit. The state Department of Human Services memo describes current NJ FamilyCare policy program-wide.

If you are not in a plan: type 2 diabetes yes with service authorization, Virginia's name for prior approval. The GLP-1 medicines class is closed and preferred agents require a type 2 diabetes diagnosis. Obesity yes with service authorization. GLP-1 receptor agonists indicated for weight loss need a BMI above 40, or above 37 with dyslipidemia, hypertension or type 2 diabetes, plus nutrition counseling, a physical activity program and no concurrent GLP-1. Wegovy and Saxenda have a minimum age of 12 and Zepbound 18. Wegovy, Zepbound and Saxenda sit non-preferred in a closed Weight Management Agents class. Virginia publishes a separate service authorization form for GLP-1 receptor agonists used for cardiovascular risk reduction. Commonwealth of Virginia Department of Medical Assistance Services Service Authorization Form: Weight-Loss Management, effective 2026-07-01. Checked 2026-09-04.

Who sets the rule: Virginia's preferred drug list and Common Core Formulary apply to the Medicaid fee-for-service populations and to non-dual members covered under the Managed Care Program.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity no. Apple Health does not cover Wegovy for weight loss, under WAC 182-530-2100(1)(b)(i). It does cover Wegovy, with prior approval, at age 18 or over with a BMI of 27 or higher, no diabetes and an HbA1c of 6.5 percent or lower, established cardiovascular disease, and already taking preventive heart medication. Wegovy is also covered with prior approval for moderate to severe non-cirrhotic MASH liver disease at fibrosis stage F2 or F3 with at least one cardiovascular risk factor. The policy took effect February 1, 2026. Anorexiants/Anti-Obesity: GLP-1 Receptor Agonists, Wegovy (semaglutide), Medical policy no. 61.25.20.AA-4, effective 2026-02-01. Checked 2026-09-04.

Who sets the rule: All managed care plans and the fee-for-service program serving Apple Health clients use the Apple Health preferred drug list, and all plans use the same prior approval criteria, step therapy edits and limits on how much can be dispensed developed by HCA.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity no. The AHCCCS fee-for-service pharmacy manual lists medications used for weight loss treatment among items not covered. AHCCCS maintains a statewide drug list and prior approval criteria through its Pharmacy and Therapeutics Committee. AHCCCS publishes no GLP-1 cardiovascular criteria. AHCCCS Fee-For-Service Provider Billing Manual, Chapter 12 Pharmacy Services. Checked 2026-09-04.

Who sets the rule: The AHCCCS Pharmacy and Therapeutics Committee makes recommendations on a statewide drug list and prior approval criteria.

If you are not in a plan: type 2 diabetes yes with prior approval. Obesity yes with prior approval. Wegovy injection and the Zepbound single dose prefilled pen are preferred GLP-1 weight management agents; Saxenda and liraglutide are non-preferred. Adults need a BMI above 30, or above 27 with a weight-related comorbidity, plus nutritional and lifestyle participation; patients under 18 need weight above the 95th percentile for age and sex. Wegovy is also covered for cardiovascular risk reduction at an initial BMI above 27 with prior myocardial infarction, prior stroke or symptomatic peripheral arterial disease, on guideline-directed therapy. Zepbound is covered for obstructive sleep apnea and Wegovy for MASH liver disease, formerly called NASH. TennCare Prior Authorization Form: Weight Management Agents, effective 2026-08-01. Checked 2026-09-04.

Who sets the rule: TennCare runs one statewide preferred drug list and prior approval process through Optum Rx. The forms name the three TennCare managed care organizations as BlueCare, UnitedHealthcare Community Plan and Wellpoint.