THE SHORT ANSWER
Does Medicaid Cover Zepbound?
Always Verify Coverage With Your State Medicaid Program
Medicaid coverage changes frequently. States can modify, add, or remove coverage at any time due to budget constraints or policy changes. Before assuming you have (or don't have) coverage, call your state Medicaid program directly to verify current Zepbound coverage status.
Coverage Varies Dramatically by State
Only 13 states (as of January 2026) had Medicaid programs covering GLP-1 obesity drugs like Zepbound or Wegovy, and Massachusetts has since ended its coverage (July 3, 2026). Most state Medicaid programs either don't cover anti-obesity medications at all, or are actively ending coverage due to budget constraints. Some states cover specific GLP-1s but not others.[1][2][9]
Unlike commercial insurance or Medicare, Medicaid coverage for weight loss medications is entirely optional for states. Federal law doesn't require states to cover anti-obesity drugs, which means:
- Only about a quarter of states (13 states (as of January 2026)) covered GLP-1 weight loss medications like Zepbound[1][2][9]
- Coverage is shrinking—several states are ending or restricting coverage in 2025-2026[8]
- Even in states with coverage, strict prior authorization (PA) requirements apply—your doctor must get approval before the medication is covered[13]
- Diabetes coverage is different—GLP-1 medications are typically covered for type 2 diabetes in all states[10]
Bottom line: If you have Medicaid, your coverage depends entirely on your state's policies. Check with your state Medicaid program directly to confirm whether Zepbound is covered for weight loss.
For a complete overview of getting Zepbound covered regardless of insurer, see our full coverage guide.
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STATE-BY-STATE MEDICAID COVERAGE
Which States Cover Zepbound?
Based on KFF's January 2026 Medicaid report and state Medicaid documents checked in October 2026, here's where coverage stands in the states we track:[1][2]
Coverage Is Changing Rapidly
State Medicaid coverage for weight loss drugs is in flux. Several states have recently ended or announced plans to end coverage. Always verify with your state Medicaid program before assuming coverage.
States With Medicaid GLP-1 Obesity Coverage
Note: This table is not exhaustive. Some states cover specific GLP-1s (e.g., Wegovy) but not others (e.g., Zepbound). Other states not listed may offer partial coverage. Always verify directly with your state Medicaid program.
| State | Coverage Status | Key Details | Last Verified |
|---|---|---|---|
| Delaware | Covered (PA) | Zepbound pen and KwikPen and Wegovy pen are preferred; prior authorization with clinical criteria for the whole class[23] | Oct 2026 |
| Kansas | Covered (PA) | Wegovy and Zepbound are on the state's anti-obesity PA criteria; check current preferred status with KanCare[24] | Oct 2026 |
| Michigan | Restricted 1/1/2026 | Now requires morbid obesity + failure of all other interventions (including preferred PDL agents) + use to avert bariatric surgery; PAs approved before 1/1/2026 honored for their remaining six months[20] | Oct 2026 |
| Minnesota | Covered (PA) | Wegovy and Saxenda preferred; Zepbound non-preferred (may need to try a preferred drug first)[25] | Oct 2026 |
| Mississippi | Covered (PA) | Zepbound preferred for adults since July 1, 2026; BMI ≥30, or 27–29 with a weight-related condition[26] | Oct 2026 |
| North Carolina | Covered (clinical criteria) | Coverage reinstated December 12, 2025; the October 2026 PDL lists Zepbound pen/KwikPen and Wegovy as preferred, and plans may not add extra prior authorization rules[5] | Oct 2026 |
| Wisconsin | Covered (PA) | Since July 1, 2026, Zepbound and Foundayo are the preferred weight-management drugs (PA required); Wegovy is no longer covered for adult obesity[27] | Oct 2026 |
States That Don't Cover GLP-1s for Weight Loss
| State | Status | Notes | Last Verified |
|---|---|---|---|
| California (Medi-Cal) | Ended 1/1/2026 | Weight-loss coverage ended; Zepbound was removed from the formulary, with PA considered for sleep apnea. Other GLP-1 uses (diabetes, cardiovascular, MASH) continue[3] | Oct 2026 |
| Connecticut | Sleep apnea only | Zepbound covered for obstructive sleep apnea in adults 18+; GLP-1s are not covered for weight loss[28] | Oct 2026 |
| Massachusetts (MassHealth) | Ended 7/3/2026 | No longer covers Wegovy or Zepbound for weight loss; still covered with PA for cardiovascular risk reduction, sleep apnea or MASH (Wegovy is the preferred drug)[29] | Oct 2026 |
| New Hampshire | Ended 1/1/2026 | No coverage for weight loss-only prescriptions; coverage continues for type 2 diabetes, cardiovascular risk reduction, severe sleep apnea and MASH[21] | Oct 2026 |
| Pennsylvania | Ended 1/1/2026 | GLP-1s no longer covered for overweight and obesity in adults; Saxenda not covered for any use; diabetes, sleep apnea and cardiovascular uses still covered with PA[19] | Oct 2026 |
| South Carolina | Ended 1/1/2026 | Obesity coverage eliminated; type 2 diabetes coverage continues[1] | Jan 2026 |
| Vermont | Other uses only | Drugs used for weight loss are excluded; Wegovy is covered with PA for cardiovascular risk reduction and Zepbound for sleep apnea[30] | Oct 2026 |
| Texas | Other uses only | No GLP-1 coverage for weight loss; Zepbound PA criteria cover moderate-to-severe sleep apnea[31] | Oct 2026 |
| Washington (Apple Health) | Other uses only | Zepbound and Wegovy are not covered for weight loss; Zepbound with PA for sleep apnea, Wegovy for cardiovascular risk reduction or MASH[32] | Oct 2026 |
| Arizona (AHCCCS) | Not covered | Medications used for weight loss are excluded from AHCCCS pharmacy coverage[33] | Oct 2026 |
| New York | Proposed only | Senate Bill 5798 (2025) would add coverage; still in committee and not enacted[34] | Oct 2026 |
Note: Coverage status as checked in October 2026. States frequently change policies—always verify directly with your Medicaid program. Other states may also offer partial or full coverage not listed above.
How to Check Your State's Coverage
Call Script for Medicaid
"Hi, I'm calling to check prescription drug coverage under my Medicaid plan. My member ID is [NUMBER]. I need to know:
- Is Zepbound (tirzepatide) covered for chronic weight management?
- What are the prior authorization requirements?
- What BMI and documentation do I need?
- Is there step therapy—do I need to try other medications first?
- Can you send me the coverage criteria in writing?"
2025-2026 MEDICAID CHANGES
States Ending Coverage
Due to budget pressures and the high cost of GLP-1 medications, several states have announced they're ending or restricting Medicaid coverage for weight loss drugs:
California (Medi-Cal) Ended Coverage January 1, 2026
As of January 1, 2026, Medi-Cal no longer covers GLP-1 medications for weight loss. This includes Zepbound, Wegovy, and Saxenda when prescribed for obesity. All prior authorizations for weight loss indications ended December 31, 2025.[3][14]
Coverage continues for:
- Type 2 diabetes (Ozempic, Mounjaro, Rybelsus, Victoza, others), with a diabetes diagnosis
- Cardiovascular disease (Wegovy, with PA)
- Obstructive sleep apnea (Zepbound was removed from the formulary, but PA requests are considered for sleep apnea)
- MASH (noncirrhotic, with moderate-to-advanced liver fibrosis) (Wegovy; no PA needed since April 1, 2026)
- Members under 21 (via federal EPSDT requirements—Early and Periodic Screening, Diagnostic and Treatment, which mandates medically necessary care for children)
If you're affected: Ask your doctor whether another condition you have (such as sleep apnea, diabetes or heart disease) is a covered use. Lilly Cares does not list Zepbound, so it is not an option. Members denied coverage can generally request a State Hearing within 90 days of the notice.
North Carolina Reinstated Coverage December 12, 2025
Good news: After briefly ending coverage on October 1, 2025, NC Medicaid reinstated GLP-1 weight management coverage on December 12, 2025 per the Governor's directive.[5]
NC Medicaid's Preferred Drug List has a GLP-1 weight management class with clinical criteria for coverage; the October 2026 list shows Zepbound (pen and KwikPen), Wegovy and Foundayo as preferred. Plans may not add their own prior authorization rules on top of the state's.
Pennsylvania Ended Adult Coverage January 1, 2026
Pennsylvania Medicaid ended coverage for GLP-1s prescribed for weight loss for adults age 21+ effective January 1, 2026. Existing prior authorizations stopped being valid after December 31, 2025, even for other conditions, so anyone continuing needed a new one. Saxenda is no longer covered for any use.[19]
Coverage continues for:
- Members under 21 (via federal EPSDT requirements for medically necessary obesity treatment)
- Adults with diabetes, obstructive sleep apnea, or cardiovascular indications (via PA)
Michigan Restricted Coverage January 1, 2026
Michigan Medicaid made GLP-1 coverage significantly more restrictive effective January 1, 2026, due to state budget law.[20]
New requirements include:
- Morbid obesity diagnosis
- Failure of all other weight loss interventions and PDL agents
- Use must be to avert bariatric surgery
Current prior authorizations will be honored for 6 months, then new stricter criteria apply at renewal. Diabetes indications remain unchanged.
South Carolina Ended Obesity Coverage
South Carolina Medicaid eliminated coverage of GLP-1 medications for obesity treatment (effective January 1, 2026, per news reports).[1]
Coverage may continue for:
- Type 2 diabetes indications (Mounjaro, Ozempic)
- Members under 21 (federal EPSDT rules require medically necessary care for children)
If you're a South Carolina Medicaid member affected by this change, ask your doctor whether another condition you have is a covered use. Lilly Cares does not list Zepbound, and Novo Nordisk's program does not list Wegovy.
Why States Are Cutting Coverage
State Medicaid programs are facing unsustainable costs from GLP-1 medications:
- Zepbound costs about $1,086/month at list price—multiplied across thousands of beneficiaries[6]
- Medicaid drug spending on GLP-1s has increased dramatically since 2020[1]
- Budget constraints force states to make difficult coverage decisions
- Unlike commercial insurance, states can't spread costs across a broader risk pool
According to KFF, states that do cover GLP-1s for obesity report significant budget impacts, leading several to reconsider or restrict coverage going forward.[1]
🗓️ CMS BALANCE Model: Voluntary for States
On December 23, 2025, CMS announced the BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth)—a voluntary model offering states negotiated GLP-1 pricing. Status: Voluntary for states, which can join between May 2026 and January 1, 2027; no participating state has been confirmed.[22][15]
Key dates:
- May 2026 – January 1, 2027: State Medicaid programs can begin participating; no participating state has been confirmed
- Medicare (separate program): the Medicare GLP-1 Bridge is live July 1, 2026 – December 31, 2027 with a $50 per monthly fill copay
- Medicare Part D BALANCE: Delayed, with no new start date
What this means:
- States can opt in for lower negotiated pricing
- CMS negotiates standardized coverage criteria on behalf of participating states
- States that cut coverage (like CA) could reconsider if lower pricing is available, but none has announced it
- Members getting a GLP-1 through BALANCE get access to a manufacturer-provided lifestyle support program at no cost
Important: No state has been confirmed as a participant. States must voluntarily participate, so check with your state Medicaid program before counting on any change.
MEDICAID CRITERIA FOR ZEPBOUND
Prior Authorization Requirements
In states that cover Zepbound through Medicaid, expect prior authorization. Medicaid PA requirements vary by state and can be stricter than commercial insurance:
Typical Medicaid PA Criteria
| Requirement | Typical Medicaid | Notes |
|---|---|---|
| BMI (body mass index) Threshold | ≥30, or ≥27 with a weight-related health condition | Some states require higher BMI (≥35) |
| Qualifying Health Conditions | High blood pressure, type 2 diabetes, high cholesterol, sleep apnea, heart disease | Must be documented in your medical records |
| Lifestyle Documentation | 3-12 months of diet/exercise attempts (varies by state) | Ask for your state's exact documentation rules in writing |
| Try Other Meds First | Required in some states | May need to try phentermine or other weight loss medications first |
| Progress Requirements | 5% weight loss for renewal | Some states require you to show ongoing progress |
| Initial Approval Length | 3-6 months typical | You may need to reapply for continued coverage |
Documentation Checklist
Before your doctor submits a Medicaid PA request, ensure these are documented:
Required Documentation
- Current height and weight (measured within the last 30 days)
- BMI calculation documented by your doctor
- Diagnosis of obesity or weight-related conditions—your doctor should have these on file:
- Obesity (mild, moderate, or severe)
- High blood pressure
- Type 2 diabetes
- High cholesterol
- Sleep apnea
- 6+ months of diet and exercise efforts—notes from doctor visits, dietitian referrals, or gym membership records
- Previous weight loss attempts—what you've tried before and why it didn't work long-term
Documentation That Strengthens Your Case
- Weight history showing obesity over the past 2-3 years
- Records of past weight loss medications you've tried (and the results)
- Recent lab work—blood sugar (A1C), cholesterol panel
- Sleep study results if you've been tested for sleep apnea
- Notes about how your weight affects your daily life (difficulty walking, joint pain, etc.)
- Any hospital or ER visits related to weight complications
For complete PA preparation guidance, see our Zepbound prior authorization guide.
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ALTERNATIVE OPTIONS
If Your State Doesn't Cover Zepbound
If your state Medicaid program doesn't cover Zepbound for weight loss, you still have options:
Check for Alternative Diagnosis Coverage
Zepbound is FDA-approved for obstructive sleep apnea (a condition where breathing stops repeatedly during sleep) in adults with obesity. Your Medicaid may cover it for sleep apnea even if weight loss is excluded.
- Ask your doctor about a sleep study if you snore heavily, wake up tired, or stop breathing during sleep
- If your sleep test shows moderate-to-severe sleep apnea, this could be an alternative coverage pathway
- Several states in the table above cover Zepbound for sleep apnea even though they don't cover it for weight loss
Explore Patient Assistance Programs
Eli Lilly offers patient assistance for qualifying individuals:
- Lilly Cares Foundation—not an option for Zepbound: Zepbound, Mounjaro and Foundayo are not on Lilly Cares’ medication list
- Eligibility—Lilly Cares serves people who are uninsured or on Medicare, not Medicaid (Uninsured or on Medicare Part D/Part B, with income limits of 300–500% of the federal poverty level by drug)
- Other Lilly drugs—ask your doctor whether a listed Lilly medication fits your needs
See our patient assistance guide for details.
Consider TrumpRx or Cash-Pay Options
Several direct-purchase options are now available:
- TrumpRx—federal site launched February 5, 2026; TrumpRx lists the manufacturers’ own self-pay prices (not a separate, cheaper price). For Zepbound that's the LillyDirect price below (available to anyone paying cash)
- LillyDirect—self-pay vials: $299/month for 2.5mg starter dose, $399/month for 5mg, $449/month for maintenance doses (7.5mg-15mg)[11]
Learn more at our Zepbound cost guide.
Consider Foundayo (New Oral GLP-1)
Foundayo (orforglipron) is Eli Lilly's new oral GLP-1, FDA-approved April 2026:
- Daily pill—no injections required
- $149–$299/month via LillyDirect self-pay (by dose)
- Best for patients who prefer pills over injections or can't tolerate injectables
- Medicaid coverage varies by state (Mississippi, North Carolina and Wisconsin list it as preferred)—check with your program
Learn more: Foundayo cost guide | Foundayo Medicaid coverage
Explore Other Covered Medications
If your state covers any weight loss medications, it may cover older options (some states that exclude GLP-1s still cover phentermine or orlistat):
- Phentermine—lower cost; covered by some state Medicaid programs
- Contrave—covered by some state Medicaid programs
- Qsymia—less commonly covered, but worth checking
If Coverage Recently Ended
If you were previously on Zepbound and your state ended coverage (like California or Pennsylvania), talk to your doctor about:
- Switching to a different weight loss medication that's still covered
- Whether other health conditions (diabetes, heart disease risk, sleep apnea) might still qualify for coverage
- Self-pay options such as LillyDirect (Lilly Cares does not list Zepbound)
- Appealing if you believe coverage should continue based on your medical situation
MEDICAID ZEPBOUND COVERAGE
Frequently Asked Questions
It depends entirely on your state. Only 13 states (as of January 2026) had Medicaid programs that covered GLP-1 weight-loss drugs like Wegovy or Zepbound, and Massachusetts has since ended its coverage (July 3, 2026). Most states either don't cover anti-obesity medications at all, or have ended or restricted coverage due to budget constraints. Some states cover specific GLP-1s but not others. Medicaid coverage for GLP-1 medications used to treat type 2 diabetes is much more widespread.
As checked in October 2026, states whose Medicaid programs cover GLP-1s for obesity (with prior authorization or clinical criteria) include: Delaware, Kansas, Minnesota, Mississippi, North Carolina and Wisconsin; Michigan covers them only under strict criteria since January 1, 2026. States that recently ended weight-loss coverage include California, New Hampshire, Pennsylvania and South Carolina (January 1, 2026) and Massachusetts (July 3, 2026). Connecticut, Texas, Vermont and Washington cover Zepbound only for sleep apnea (and Wegovy only for other uses where listed), Arizona excludes weight-loss drugs, and New York's proposed coverage (Senate Bill 5798) has not been enacted. Always call your state Medicaid program to verify current coverage.
California's 2025-26 state budget eliminated Medi-Cal coverage for GLP-1 weight loss medications (Zepbound, Wegovy, Saxenda) effective January 1, 2026. All prior authorizations ended December 31, 2025. The decision was driven by budget constraints. Coverage continues for diabetes, cardiovascular disease (Wegovy) and MASH (Wegovy); Zepbound was removed from the formulary, but PA requests are considered for obstructive sleep apnea.
Typical requirements include: BMI of 30 or higher (or 27+ with a weight-related health condition like high blood pressure, type 2 diabetes, high cholesterol, or sleep apnea), 6+ months of documented diet and exercise efforts, and, in some states, a requirement to try other weight loss medications first. Some states also require ongoing weight loss (at least 5%) for continued coverage. Requirements vary by state—ask for your state's specific criteria in writing.
If your state doesn't cover Zepbound for weight loss, you have options: (1) Ask if sleep apnea coverage applies—Zepbound is FDA-approved for sleep apnea and may be covered for that condition; (2) Consider LillyDirect cash-pay ($299–$449/month; TrumpRx lists the same prices); (3) Note that Lilly Cares does not list Zepbound, so it is not a route to free Zepbound; (4) Ask your doctor about other Lilly options; (5) Try Foundayo (oral GLP-1, $149–$299/month); (6) Ask about other covered medications like phentermine.
Yes, in most states. While Zepbound is primarily approved for weight loss, Mounjaro (the same medication under a different name) is approved for type 2 diabetes and is generally covered by Medicaid in all states when prescribed for diabetes. If you have both obesity and type 2 diabetes, your doctor may be able to prescribe it for your diabetes instead.
Medicaid appeal processes vary by state. Medicaid health plan: appeal within 60 days of the denial notice; the plan decides within 30 days (72 hours if urgent); then you can ask for a state fair hearing (your state allows 90–120 days). Fee-for-service Medicaid: ask for a fair hearing within your state’s deadline (no more than 90 days). Request your denial letter in writing with the specific reason for denial. Then gather documents that address that reason (a letter from your doctor explaining medical necessity, your weight records, documentation of diet/exercise efforts). At a fair hearing you can present your case to a state hearing officer. Check your denial notice for your exact deadlines.
The BALANCE Model (announced December 23, 2025) is a voluntary CMS program offering states negotiated GLP-1 pricing. Status: Voluntary for states, which can join between May 2026 and January 1, 2027; no participating state has been confirmed. CMS negotiates the price and coverage criteria, and members get a manufacturer-provided lifestyle support program. States that cut coverage (like California) could reconsider, but participation is voluntary and none has been confirmed.
YOUR PATH FORWARD
What's Next
Zepbound Coverage: Other Insurance Options
Coverage varies significantly by program type. See our guides:
- Medicare — basic Part D coverage excludes drugs used for weight loss; the separate Medicare GLP-1 Bridge covers the Zepbound KwikPen (with conditions, including prior authorization)
- TRICARE — Covers with BMI ≥30 and documented comorbidity
- ACA Marketplace — Very rare coverage; ~1% of plans
- Blue Cross Blue Shield — Major 2026 coverage restrictions
- Aetna — Most plans exclude; limited employer exceptions with PA
Other GLP-1 Medications on Medicaid
Medicaid coverage varies by state and medication. Compare your options:
References
- KFF. (January 16, 2026). "Medicaid Coverage of and Spending on GLP-1s." 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026; California, New Hampshire, Pennsylvania and South Carolina eliminated coverage. kff.org
- STAT News. (2024). "More state Medicaid programs consider covering GLP-1 drugs." October 23, 2024. Confirms 13 state Medicaid programs cover GLP-1s for obesity. statnews.com
- California Department of Health Care Services. (2025). "State Budget Updates: Medi-Cal Rx Coverage Changes Effective January 2026." medi-calrx.dhcs.ca.gov
- UnitedHealthcare. (2025). "Zepbound and Phentermine Added to Preferred Drug List." Massachusetts Medicaid. January 1, 2025. uhcprovider.com
- NC Department of Health and Human Services. (2025). NC Medicaid GLP-1 coverage initially ended October 1, 2025, then reinstated December 12, 2025 per Governor's directive. January 2026 PDL includes GLP-1 weight management class with clinical criteria. medicaid.ncdhhs.gov
- SingleCare. (2025). "Does Medicaid Cover Zepbound for Weight Loss?" Updated October 2025. singlecare.com
- GoodRx. (2025). "Does Medicaid Cover Ozempic, Wegovy, and Other GLP-1 Medications?" Updated August 2025. goodrx.com
- KFF Health News. (2025). "As Insurers Struggle With GLP-1 Drug Costs, Some Seek To Wean Patients Off." September 4, 2025. kffhealthnews.org
- National Conference of State Legislatures (NCSL). (2025). "GLP-1 Medications for Obesity: A Growing Challenge for States." October 2025. Confirms 13 states offer Medicaid coverage. ncsl.org
- National Association of Medicaid Directors (NAMD). (2025). "Optional Not Mandatory: NAMD's Recommendations on Anti-Obesity Medication Coverage." February 2025. medicaiddirectors.org
- Eli Lilly. (2026). "Zepbound Coverage and Savings." LillyDirect Self Pay: $299/month for 2.5mg, $399/month for 5mg, $449/month for 7.5-15mg. zepbound.lilly.com
- Lilly Cares Foundation. (2025). "Patient Assistance Program." Free medications for up to 12 months for qualifying patients with financial need. lillycares.com
- Eli Lilly. (2025). "Zepbound Prior Authorization Resource Guide." PA criteria including BMI thresholds and documentation requirements. zepbound.lilly.com
- California Medical Association. (2025). "DHCS details new Medi-Cal Rx policy changes effective January 2026." October 16, 2025. cmadocs.org
- NCPA. (November 11, 2025). "About the Trump, Eli Lilly, Novo Nordisk deals on GLP-1 prices." ncpa.org
- Axios. (November 6, 2025). "Trump announces Medicare coverage of weight-loss drugs." Includes Medicaid pricing details. axios.com
- AARP. (November 2025). "When Will the Cost of GLP-1 Weight Loss Drugs Go Down?" aarp.org
- CBS News. (November 6, 2025). "Trump announces deal to lower weight loss drug prices in some cases." cbsnews.com
- Pennsylvania Department of Human Services. (January 2026). Pennsylvania Medicaid ended adult (21+) GLP-1 coverage for weight loss effective January 1, 2026. Coverage continues for under-21 (EPSDT) and adults with diabetes, OSA, or cardiovascular indications via PA.
- Michigan Department of Health and Human Services. (January 2026). Michigan Medicaid GLP-1 coverage became more restrictive January 1, 2026 due to state budget law. Now requires morbid obesity, failure of all interventions, and use to avert bariatric surgery. Existing PAs honored 6 months.
- New Hampshire Department of Health and Human Services. (January 2026). New Hampshire Medicaid ended coverage for GLP-1s prescribed solely for weight loss effective January 1, 2026. Coverage continues for other chronic conditions.
- CMS. (December 23, 2025). "BALANCE Model: Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth." Voluntary model for state Medicaid agencies to access negotiated GLP-1 pricing; states can join between May 2026 and January 1, 2027. cms.gov
- Delaware Medicaid. (2026). Preferred Drug List, effective October 5, 2026: Obesity Treatment Agents. dhss.delaware.gov
- Kansas Department of Health and Environment. Anti-Obesity Medications prior authorization criteria. kdhe.ks.gov
- Minnesota DHS. (2026). Uniform Preferred Drug List, effective August 4, 2026: Weight Management Agents. mn.gov
- Mississippi Division of Medicaid. (2026). Anti-Obesity Select Agents PA Criteria, effective July 1, 2026. medicaid.ms.gov
- Wisconsin ForwardHealth. (June 2026). Update No. 2026-15: weight management agents added to the PDL effective July 1, 2026. forwardhealth.wi.gov
- Connecticut DSS. (2026). Fair hearing decision citing Provider Bulletin 2025-32 (Zepbound for obstructive sleep apnea, effective July 1, 2025) and weight-loss coverage limited to orlistat and phentermine. portal.ct.gov
- MassHealth. (March 12, 2026). Pharmacy Facts #271: drugs used for the treatment of obesity or overweight no longer covered effective July 3, 2026. mass.gov
- Vermont DVHA. (October 2, 2026). Vermont Medicaid Preferred Drug List: drugs used for weight loss excluded from coverage. dvha.vermont.gov
- Texas Medicaid PA program (Acentra). (October 24, 2025). Zepbound clinical prior authorization criteria (obstructive sleep apnea). acentra.com
- Washington Health Care Authority. Apple Health clinical policies: tirzepatide (Zepbound), effective May 1, 2025, and semaglutide (Wegovy), effective February 1, 2026. hca.wa.gov; hca.wa.gov
- AHCCCS. Fee-for-Service Provider Billing Manual, Chapter 12 (Pharmacy): excluded "Medications used for weight loss treatment." azahcccs.gov
- New York State Senate. Senate Bill S5798 (2025–2026 session), status: in committee. nysenate.gov
Last updated October 6, 2026 · Key facts verified October 5, 2026 · Full page reviewed October 5, 2026
Disclaimer
The information on this page is for educational and informational purposes only and is not intended as medical advice. Honest Care does not provide medical diagnosis, treatment, or individualized recommendations. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition or treatment.
While this content has been reviewed for accuracy and balance, new evidence may emerge after publication. Drug availability, indications, and insurance coverage can change over time. Honest Care makes no warranties as to completeness or currentness of the information and is not responsible for decisions made based on this content.