Does Delaware Medicaid cover GLP-1s for weight loss?

Delaware Medicaid covers GLP-1 receptor agonists for obesity, subject to prior authorization. Coverage for type 2 diabetes, for Wegovy's cardiovascular indication and for Zepbound in moderate to severe sleep apnea is required of every state program regardless. So the practical question at a denial is rarely "does my state cover it" but "which indication am I being prescribed this under". The published threshold is: 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. Those criteria are quoted from Delaware DMAP prior authorization request: GLP-1 agonist for weight management, MASH or prevention of MACE, read directly rather than summarized from an aggregator. Last checked 2026-09-05.

What the prior authorization asks for

BMI threshold: 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.
Tried first: Two preferred products first — Wegovy, Wegovy HD, Zepbound, Contrave and phentermine are the preferred ones; Saxenda, Foundayo, Xenical and the oral Wegovy are not. The agent has to be used with a reduced-calorie diet and increased physical activity, a pharmacy claims history has to be attached, and no second GLP-1 may run alongside it.
To keep it: At least 5% of baseline weight for adults and 4% for adolescents, then another 6 months in 90-day supplies. Regaining more than half of what was lost, or falling back under those thresholds at any point, can block renewal for a year.
Age: Within the FDA-approved range for the drug requested; the pediatric threshold is the 95th percentile.
Approval runs for: 6 months, then 6-month renewals

The BMI criteria are in Delaware's prior-authorization form, not in the PDL. The PDL, now effective 7 September 2026, is what makes Wegovy, Wegovy HD, Zepbound, Contrave and phentermine preferred and requires two preferred products before any non-preferred one; every agent in the class needs prior authorization either way.

Both tools fill from these criteria rather than from a template — a prior authorization for Delaware, or a letter appealing a denial. If the plan is not Medicaid, the 9 insurer and program pages cover a different set of rules.

Whatever Delaware decides about obesity, federal law still makes it cover a GLP-1 prescribed for type 2 diabetes, Wegovy for cardiovascular risk reduction and Zepbound for obstructive sleep apnea — the exclusion is written against the use, not the drug. Which approval a weight-loss exclusion cannot reach, and what each label says.

If you end up paying cash

The cheapest verified GLP-1 routes — what you pay per month once titrated, not an introductory rate:

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

Go to Strut Health, the cheapest verified route ↗

Every verified price, ranked and segmented →

Cheaper still, and a different class: Qsymia (phentermine/topiramate) at $75/mo — about 9.8% mean weight loss in its trial, against roughly 15 to 21% for the GLP-1s above. It is a real option and it is not a substitute.

The manufacturer programs cut the first fills further, and each one's catch is printed with it. Write the appeal first if you were refused — it costs nothing and the criteria above are what it has to answer.

Other states with criteria of their own

Source: Delaware DMAP prior authorization request: GLP-1 agonist for weight management, MASH or prevention of MACE , effective 2026-04-20. Read on 2026-09-05. Fee-for-service rules; a managed-care plan in Delaware can publish its own formulary and step edits. This is a record of what the payer publishes, not medical or legal advice.