Does Medicaid cover Ozempic, Wegovy or Zepbound where you live?
In 11 of the 51 Medicaid programs, yes — for obesity, under prior authorization. In 7 more, a weight-loss drug is covered but no GLP-1 is. In the remaining 33, the answer for obesity is no, and the drug is only reachable on another diagnosis or in cash.
That yes-or-no map is the part every site copies, and it is the part that misleads. Michigan counts as covering and, since 1 January 2026, approves only morbid obesity, only after every other intervention has failed, and only to avert bariatric surgery. Virginia counts as covering and refuses a BMI of 37 with no risk factor. Massachusetts counted as covering until 3 July 2026 and now covers none of it. So the criteria are printed here beside the status, each with the document they were read from and the date on that document.
What every state has to cover, whatever its list says
- Type 2 diabetes. Ozempic, Mounjaro and the rest are required benefits on that indication in all 51 programs. The weight-loss exclusion is written against the use, not the molecule.
- Wegovy for cardiovascular risk, since the FDA approved that indication in March 2024 — required, including in states that refuse it for obesity.
- Zepbound for moderate to severe obstructive sleep apnea in adults with obesity, approved December 2024 — also required.
- Anyone under 21, where a clinician documents medical necessity, through the EPSDT benefit.
Which is why the practical question at a denial is rarely “does my state cover it” but “which indication am I being prescribed this under”. A cardiovascular or sleep-apnea diagnosis moves the request out of the optional column entirely.
- Cover a GLP-1 for obesity11 programs
- Cover other weight-loss drugs only7 programs
- Cover none for obesity33 programs
programs
All 51 programs
Status from KFF's 16 January 2026 analysis (fee-for-service), updated where a state has published a change since — Massachusetts ended coverage on 3 July 2026, and Utah's weight-loss pilot ran out on 30 June 2026. Criteria read from each state's own prior-authorization document — 11 of the 11 covering states so far; the rest say so rather than guess.
Last updated 2026-09-13 — the most recent state document read. Read and dated by Alex Seot.
| State | GLP-1s for obesity | BMI threshold | Criteria source |
|---|---|---|---|
| AlabamaAlabama Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Alabama Medicaid Preferred Drug List Reference Tool2026-07-01 |
| AlaskaAlaska Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Alaska Administrative Code, 7 AAC 120.112 (Justia copy)2025-05-30 |
| ArizonaArizona Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | AHCCCS Fee-for-Service Provider Manual, Chapter 12: Pharmacy2024-03-11 |
| ArkansasArkansas Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Arkansas Medicaid Pharmacy Program provider memo2026-05-13 |
| California | Not covered for obesity | not read yet | Medi-Cal Rx: Changes to GLP-1 Drug Coverage, effective 1 January 20262026-01-01 |
| ColoradoColorado Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Colorado Medicaid Preferred Drug List2026-07-01 |
| Connecticut | A weight-loss drug, but no GLP-1 | not read yet | Connecticut DSS Provider Bulletin 2025-31: GLP-1 diagnosis requirement, and coverage of phentermine and orlistat2025-07-01 |
| Delaware | Covered, with prior authorization | Adults 30 or more. A BMI of 27 to 29.9 qualifies with at least one of cardiovascular disease, heart failure, chronic kidney disease stage 3a or above, hypertension, hyperlipidemia, peripheral artery disease, moderate to severe sleep apnea with an apnea-hypopnea index above 15, or type 2 diabetes. Under 18: at or above the 95th percentile for age and weight. | Delaware DMAP prior authorization request: GLP-1 agonist for weight management, MASH or prevention of MACE2026-04-20 |
| District of ColumbiaDistrict of Columbia Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | District of Columbia Medicaid Preferred Drug List2026-09-08 |
| FloridaFlorida Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Florida Medicaid Prescribed Drug Services Coverage Policy, Rule 59G-4.2502017-12-01 |
| GeorgiaGeorgia Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Georgia Medicaid Preferred Drug List by drug class2026-08-01 |
| HawaiiHawaii Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | KFF, Medicaid Coverage of and Spending on GLP-1s2026-01-16 |
| IdahoIdaho Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Idaho Administrative Code, IDAPA 16.03.26.212: Prescription Drugs, Coverage and Limitations (Cornell LII copy)2025-07-01 |
| IllinoisIllinois Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Illinois HFS Handbook for Providers of Pharmacy Services, Chapter P-2002016-03-01 |
| IndianaIndiana Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Indiana Medicaid Statewide Uniform Preferred Drug List2026-08-01 |
| IowaIowa Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | KFF, Medicaid Coverage of and Spending on GLP-1s2026-01-16 |
| Kansas | Covered, with prior authorization | The form records the BMI and at least one weight-related comorbidity off the state's own list — type 2 diabetes, dyslipidemia, hypertension, sleep apnea, NASH, PCOS, GERD and a dozen more. For 12–17 year olds it is the 95th percentile for age and sex. The one number the form prints, a BMI of 40 or more (at 12–17, 40 or 140% of the 95th percentile), applies only to the 'high cost' agents in Table 4 of the clinical criteria — and the form states that Zepbound has not been in that table since 1 April 2024, nor Wegovy since 1 June 2025. | KDHE Anti-Obesity Medications Prior Authorization Form2025-06-01 |
| KentuckyKentucky Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Kentucky Administrative Regulation 907 KAR 23:010, Outpatient Pharmacy Program2017-10-06 |
| Louisiana | A weight-loss drug, but no GLP-1 | not read yet | Louisiana Medicaid Services Manual, Chapter 37: Pharmacy Benefits Management Services2026-03-30 |
| MaineMaine Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | MaineCare Preferred Drug List2026-07-01 |
| MarylandMaryland Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | KFF, Medicaid Coverage of and Spending on GLP-1s2026-01-16 |
| Massachusetts | Not covered for obesity | not read yet | MassHealth Pharmacy Facts 271: Changes to Management of Anti-Obesity Agents2026-07-03 |
| Michigan | Covered, with prior authorization | Classified as morbidly obese — the state's notice does not print a figure | Michigan Medicaid health plan bulletin on MDHHS notice L 25-732026-01-01 |
| Minnesota | Covered, with prior authorization | 30 or more with no risk factor, or 27 or more with a weight-related comorbidity such as hypertension, type 2 diabetes or dyslipidemia; 12–17 year olds need 30 or more and a body weight above 60 kg | Minnesota Health Care Programs PA criteria: Anti-Obesity Medications2026-08-01 |
| Mississippi | Covered, with prior authorization | Adults 30 or more, or 27 to 29 with at least one weight-related comorbidity — hypertension confirmed by claims history, hyperlipidemia, glucose dysregulation, sleep apnea confirmed by a sleep study, cardiovascular disease or non-alcoholic fatty liver disease. At 12–17 Saxenda needs body weight above 60 kg and a BMI of 30 or more; Wegovy needs a BMI above the 95th percentile for age and sex. | Anti-obesity Select Agents PA Criteria2024-03-12 |
| Missouri | Covered, with prior authorization | 18 and over: 30 or more, or 27 or more with a documented weight-related comorbidity. 12–17: at or above the 95th percentile for age and sex. | MO HealthNet GLP-1 Receptor Agonists for All Indications prior authorization form2024-10-01 |
| MontanaMontana Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Montana Medicaid Prescription Drug Program Manual2026-07-09 |
| NebraskaNebraska Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Nebraska Medicaid Preferred Drug List2026-09-02 |
| NevadaNevada Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Nevada Medicaid Services Manual, Chapter 1200: Prescribed Drugs2026-08-31 |
| New Hampshire | A weight-loss drug, but no GLP-1 | not read yet | New Hampshire Medicaid notice: GLP-1 coverage change, effective 1 January 20262026-01-01 |
| New JerseyNew Jersey Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | New Jersey Department of Human Services: NJ FamilyCare Coverage of Weight Loss Drugs2025-09-02 |
| New Mexico | A weight-loss drug, but no GLP-1 | not read yet | New Mexico Health Care Authority: Weight Reduction Medications2025-03-04 |
| New York | Not covered for obesity | Over 40 — and only on the cardiovascular indication. Weight loss itself is excluded under section 1927(d)(2) of the Social Security Act. | NYRx Drug Coverage Overview: Wegovy2026-07-16 |
| North Carolina | Covered, with prior authorization | 18 and over: 30 or more, or 27 or more with a weight-related comorbidity — hypertension, type 2 diabetes, obstructive sleep apnea, cardiovascular disease or dyslipidemia. 12–17: the 95th percentile for age and sex, or 30, or the 85th percentile with at least one severe weight-related comorbidity. Separately, 45 and over with established cardiovascular disease qualifies at 27. Baseline weight and BMI must be measured within 45 days of the request. | NC Medicaid Outpatient Pharmacy Prior Approval Criteria — GLP-1s for Weight Management2024-08-01 |
| North Dakota | A weight-loss drug, but no GLP-1 | not read yet | North Dakota Medicaid Preferred Drug List and Prior Authorization Criteria, version 2026.62026-07-31 |
| OhioOhio Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Ohio Medicaid Unified Preferred Drug List2026-07-01 |
| OklahomaOklahoma Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Oklahoma Health Care Authority rule 317:30-5-72.1, Drug benefit2021-09-01 |
| OregonOregon Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Oregon Health Plan prior authorization criteria: Weight Management Drugs2026-03-01 |
| Pennsylvania | A weight-loss drug, but no GLP-1 | not read yet | Pennsylvania DHS Medical Assistance Bulletin of 24 November 2025: GLP-1 receptor agonists and obesity treatment agents2026-01-01 |
| Rhode Island | Covered, with prior authorization | No BMI threshold read from the document; it sets step therapy — Wegovy is the only preferred agent; Zepbound, Saxenda, oral Wegovy, Xenical, orlistat, phentermine/topiramate and Imcivree are non-preferred | Rhode Island Medicaid Fee for Service Preferred Drug List2026-01-13 |
| South CarolinaSouth Carolina Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | South Carolina Medicaid Pharmacy Services provider manual2026-07-01 |
| South DakotaSouth Dakota Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | South Dakota Medicaid Pharmacy Services billing manual2026-05-01 |
| Tennessee | Covered, with prior authorization | 18 and over: a BMI over 30, or over 27 with a weight-related comorbidity such as hypertension, dyslipidemia, diabetes, coronary heart disease, MASH/NASH or sleep apnea — documented in chart notes, not asserted. Under 18: at or above the 95th percentile for age and sex. Wegovy and Saxenda start at 12, Zepbound at 18. | Clinical Criteria, Step Therapy, and Quantity Limits for the TennCare PDL2026-09-01 |
| Texas | A weight-loss drug, but no GLP-1 | Texas publishes no threshold for obesity itself, because obesity alone is never an approvable reason: the decision tree denies at step two without a cardiovascular diagnosis. The qualifying-diagnosis list at step three does set a floor — Table 3 takes the obesity and overweight codes and the BMI codes from Z68.27, a BMI of 27.0, upwards. | Texas Prior Authorization Program Clinical Criteria — Wegovy2026-07-30 |
| Utah | Not covered for obesity | No BMI threshold read from the document; it sets step therapy — For the indications Utah still covers: Wegovy for a prior major adverse cardiovascular event needs a BMI of 27 or more with a documented MI, stroke or symptomatic peripheral arterial disease and guideline-directed secondary prevention; Zepbound for sleep apnea needs a BMI of 30 or more, an apnea-hypopnea index of 15 or higher on an attended study, a sleep specialist and 70% adherence to PAP; Wegovy for MASH needs stage F2 to F3 fibrosis confirmed two ways and a liver specialist. All of them require an exercise program and a calorie-restricted diet, no other GLP-1, GIP or DPP-4 agent, and no personal or family history of medullary thyroid carcinoma or MEN 2. | Utah Medicaid pharmacy prior authorization request form: GLP-1 medications for weight-related comorbidities, last updated 1 June 2026 (read via the Internet Archive)2026-06-01 |
| VermontVermont Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Vermont Medicaid Preferred Drug List2026-08-01 |
| Virginia | Covered, with prior authorization | over 40, or over 37 with dyslipidemia, hypertension or type 2 diabetes | Virginia Medicaid Service Authorization — Weight Loss Management2026-07-01 |
| WashingtonWashington Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Washington Apple Health clinical policy: semaglutide2026-02-01 |
| West VirginiaWest Virginia Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | West Virginia Medicaid prior authorization criteria: Wegovy2024-09-25 |
| Wisconsin | Covered, with prior authorization | 30 or more; or 27 to 29 with two or more of dyslipidemia, hypertension, sleep apnea, type 2 diabetes, and cardiovascular disease evidenced by a heart attack, coronary revascularization, angina, stroke, claudication with an ankle-brachial index of 0.9 or less, peripheral arterial revascularization or an amputation for atherosclerotic disease. At 12–17, Saxenda needs body weight above 132 lb and a BMI matching 30 for adults; orlistat, phentermine/topiramate, Wegovy and Xenical need the 95th percentile standardized for age and gender. | Prior Authorization Drug Attachment for Weight Management Agents (F-00163)2025-11-01 |
| WyomingWyoming Medicaid does not cover GLP-1s prescribed for weight loss. | Not covered for obesity | not read yet | Wyoming Medicaid Pharmacy Services Manual2024-10-10 |
What has changed
A status with no history reads as settled policy. It is not: this is a live retreat, driven by state budgets, and the direction of travel matters more than today's row if you are starting a course of treatment.
- 2026-10-01 Rhode Island — GLP-1s prescribed only for weight loss (Foundayo, Saxenda, Wegovy and Zepbound) no longer covered, under the state's fiscal 2027 budget source
- 2026-07-03 Massachusetts — Coverage of every anti-obesity agent — Wegovy, Zepbound, Saxenda, phentermine, orlistat — ended for weight loss; GLP-1s stay only for cardiovascular risk, sleep apnea, MASH or diabetes source
- 2026-07-01 Utah — The weight-loss pilot lapsed: Utah's own prior-authorization form caps every obesity authorization at 30 June 2026 and no longer has an initial-approval route for obesity source
- 2026-06-09 Louisiana — Act 898 signed: weight-loss drugs to be covered, no step therapy — in force only once money is appropriated for it source
- 2026-01-01 New Hampshire — GLP-1s for obesity eliminated; other weight-loss drugs stay source
- 2026-01-01 Michigan — Coverage kept, but narrowed to morbid obesity with documented failure of every other intervention and only to avert bariatric surgery source
- 2026-01-01 California — GLP-1s for weight loss dropped entirely; every existing approval expired on 31 December 2025 with no continuing care source
- 2026-01-01 Pennsylvania — GLP-1s for obesity eliminated; other weight-loss drugs stay source
- 2026-01-01 South Carolina — GLP-1s for obesity eliminated source
- 2025-12-12 North Carolina — Coverage reinstated, reverting to the criteria in force on 30 September 2025 source
- 2025-10-01 North Carolina — GLP-1s for obesity dropped during the state budget stalemate source
- 2025-07-31 Connecticut — GLP-1s for members without type 2 diabetes stop paying; orlistat and phentermine covered from 1 July source
If the answer is no
Two routes are left, and they are not equivalent. The first is a different indication — sleep apnea and cardiovascular risk are covered everywhere, so a denial for obesity is not the end of the conversation with your prescriber. The second is cash, where the cheapest verified GLP-1 maintenance prices on this site are:
- Strut Health$129/moverified 2026-09-22compounded, not FDA approvedFDA warning letter
- Noom Med$249/moverified 2026-09-22compounded, not FDA approved
- Found$289/moverified 2026-09-22compounded, not FDA approved
Before paying it, check the savings programs — several cut the first fills — and write the appeal, because a denial under criteria you actually meet is the cheapest thing on this page to fix.
Questions
- What GLP-1s will Medicaid cover?
- The ones prescribed for an indication the state cannot exclude, which is a question about the prescription rather than the drug. The exclusion is written against a use, not a molecule. Federal law lets a state leave 'agents used for weight loss' off its Medicaid formulary, so semaglutide prescribed for obesity is optional — while the same molecule prescribed for type 2 diabetes is a required benefit. It is also why coverage of Wegovy for cardiovascular risk reduction, an indication the FDA approved in March 2024, is mandatory in every state, and coverage of Zepbound for moderate to severe sleep apnea, approved in December 2024, is mandatory too.
- My state is on the covered list and my prior authorization was still denied. How?
- The list is a formulary status, not an entitlement. Every covering state runs prior authorization on top of it, and the criteria are where the refusals happen: Virginia wants a BMI over 40, or over 37 with dyslipidemia, hypertension or diabetes. Michigan, since 1 January 2026, approves only morbid obesity after every other intervention has failed, and only to avert bariatric surgery. North Carolina counts a trial of the preferred drug only if it ran 3 to 6 months of dose titration, so a two weeks of nausea is not a failure it will accept. Read your state's row: the criterion you missed is usually printed in it.
- Does managed care follow the state's list?
- Not necessarily. The count on this page is fee-for-service, and most Medicaid enrollees are in managed care plans that publish their own formularies. A state can cover GLP-1s while your particular plan applies a stricter step edit, and a plan can be more generous than the state. Check the formulary of the plan whose card is in your wallet, not only the state's.
- Does Medicare cover GLP-1s for weight loss?
- Not under current law — the same statutory exclusion applies, which is why Part D plans cover Ozempic for diabetes and refuse Wegovy for obesity. Two things change that at the edges: Wegovy for cardiovascular risk and Zepbound for sleep apnea are covered because those are not weight-loss indications, and CMS's Medicare GLP-1 Bridge lets Part D enrollees reach obesity drugs for $50 a month from 1 July 2026 to 31 December 2027. CMS extended the Bridge to the end of 2027 because the BALANCE model will not launch in Part D in 2027.
- Will my state start covering Wegovy through the BALANCE model?
- Only if it joins. BALANCE lets a state Medicaid program cover Mounjaro, Ozempic, Rybelsus, Wegovy, the Zepbound KwikPen and Foundayo for weight at prices CMS negotiates with the makers, and states can join from May 2026 until 1 January 2027. CMS had named no participating state when this page was checked on 10 September 2026, so no row here counts it. If your state joins, its preferred drug list will say so before any summary does.
- If my state does not cover it, what is the cheapest legal route?
- Cash, and the gap between routes is large. The manufacturers' own pharmacies sell branded semaglutide and tirzepatide direct, telehealth providers bundle a membership with a compounded or branded drug, and the savings programs on this site knock the first fills down further. What matters is the maintenance price — what you pay once titrated — because that is the figure you live with, and it is the one halfrx records with the date it was verified.
Coverage status from KFF's January 2026 analysis of state Medicaid programs; criteria from the states' own documents, linked in each row. This is a record of what payers publish, not medical or legal advice, and a plan can change its rules between our check and your prescription.