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Which states’ Medicaid covers GLP‑1s for weight loss?

In short

Medicaid covers Wegovy and Zepbound for weight loss in 8 of the 51 states we checked, with prior authorization: Delaware, Kansas, Michigan, Minnesota, Mississippi, North Carolina, Tennessee and Virginia. 5 more cover some GLP-1s, or for some people only. 38 cover none for weight loss.

Checked October 28, 2001 against each state’s own drug list. Every fact links to its source.

  • Covers Wegovy and Zepbound · 8
  • Covers some GLP-1s · 5
  • Covers none for weight loss · 38
  • Not checked yet · 0

Delaware

Delaware Medicaid covers GLP-1s for weight loss, with prior authorization.

QuestionAnswer
Delaware Medicaid, weight lossWegovy: covered with prior authorization · Zepbound: covered with prior authorization
Programs that ship there40 of the 50 we rank; 10 not confirmed
Cheapest plan that ships thereWellMedr: $492 for 12 months ($41 a month); $99 month to month
Medicaid GLP-1 prescriptions, 202555,637 · 5,249 per 100,000 residents · 7th of 51
Delaware: the full answerThe cheapest programs, ranked

Every state we have checked, side by side

DelawareCovers Wegovy and Zepbound12Ozempic: preferred · Mounjaro: preferred3Covered, with conditions · State of Delaware Group Health Insurance Plan455,249 · 7th of 51276
KansasCovers Wegovy and Zepbound67Ozempic: not confirmed · Mounjaro: not confirmed89Covered, with conditions · Kansas State Employee Health Plan101,696 · 37th of 51276
MichiganCovers Wegovy and Zepbound1112Ozempic: preferred · Mounjaro: preferred1314Not confirmed · State Health Plan PPO15165,991 · 3rd of 51276
MinnesotaCovers Wegovy and Zepbound1718Ozempic: preferred · Mounjaro: non-preferred1920Not confirmed · Minnesota Advantage Health Plan213,844 · 16th of 51276
MississippiCovers Wegovy and Zepbound2223Ozempic: preferred · Mounjaro: preferred24Not covered · State and School Employees' Health Insurance Plan25262,077 · 30th of 51276
North CarolinaCovers Wegovy and Zepbound2728Ozempic: preferred · Mounjaro: preferred2729Not covered · NC State Health Plan30314,314 · 12th of 51276
TennesseeCovers Wegovy and Zepbound3233Ozempic: preferred · Mounjaro: preferred3435Covered, with conditions · State Group Insurance Program36371,833 · 36th of 51276
VirginiaCovers Wegovy and Zepbound3839Ozempic: non-preferred · Mounjaro: non-preferred4041Covered, with conditions · COVA Care42432,515 · 24th of 51276
GeorgiaSaxenda, with limits107108Ozempic: preferred · Mounjaro: preferred107109Covered, with conditions · Georgia State Health Benefit Plan110111459 · 49th of 51276
IndianaWegovy and Saxenda, with limits4445Ozempic: preferred · Mounjaro: non-preferred4645Not covered · State of Indiana employee health plans47482,705 · 22nd of 51276
MissouriZepbound and Foundayo only4950Ozempic: preferred · Mounjaro: preferred5152Not confirmed · Missouri Consolidated Health Care Plan534,545 · 11th of 51276
TexasFoundayo only242243Ozempic: preferred · Mounjaro: non-preferred244245Not covered · HealthSelect of Texas246247538 · 48th of 51276
WisconsinWegovy, Zepbound and Foundayo only5455Ozempic: preferred · Mounjaro: preferred5657Not covered · State of Wisconsin Group Health Insurance Program58595,012 · 8th of 51276
AlabamaCovers none for weight loss6061Ozempic: preferred · Mounjaro: preferred62Not confirmed · State Employees' Health Insurance Plan63641,368 · 40th of 51276
AlaskaCovers none for weight loss6566Ozempic: preferred · Mounjaro: non-preferred6768Covered, with conditions · AlaskaCare Employee Health Plan69703,099 · 18th of 51276
ArizonaCovers none for weight loss7172Ozempic: non-preferred · Mounjaro: preferred7374Not confirmed · State of Arizona Benefit Options751,191 · 42nd of 51276
ArkansasCovers none for weight loss7677Ozempic: non-preferred · Mounjaro: non-preferred7879Not covered · ARBenefits8081546 · 47th of 51276
CaliforniaCovers none for weight loss8283Ozempic: covered · Mounjaro: covered8483Covered, with conditions · CalPERS857,821 · 1st of 51276
ColoradoCovers none for weight loss8687Ozempic: preferred · Mounjaro: preferred8886Covered, with conditions · State of Colorado employee medical plans89901,973 · 32nd of 51276
ConnecticutCovers none for weight loss9192Ozempic: not confirmed · Mounjaro: not confirmed9394Covered, with conditions · State of Connecticut Health Plan95964,722 · 10th of 51276
District of ColumbiaCovers none for weight loss9798Ozempic: preferred · Mounjaro: non-preferred99100Not confirmed · District of Columbia Employee Health Benefits Program1013,966 · 15th of 51276
FloridaCovers none for weight loss102103Ozempic: preferred · Mounjaro: preferred104103Covered, with conditions · Florida State Group Insurance105106566 · 46th of 51276
HawaiiCovers none for weight loss112113Ozempic: not confirmed · Mounjaro: not confirmed113Covered, with conditions · Hawaii Employer-Union Health Benefits Trust Fund1141152,040 · 31st of 51276
IdahoCovers none for weight loss116117Ozempic: preferred · Mounjaro: non-preferred118119Not covered · State of Idaho employee health plan1201212,259 · 27th of 51276
IllinoisCovers none for weight loss122123Ozempic: non-preferred · Mounjaro: non-preferred122123Covered, with conditions · State Employees Group Insurance Program1241252,138 · 28th of 51276
IowaCovers none for weight loss126127Ozempic: preferred · Mounjaro: preferred127128Not covered · State of Iowa employee health plans1291302,716 · 21st of 51276
KentuckyCovers none for weight loss131132Ozempic: preferred · Mounjaro: preferred133134Covered · Kentucky Employees' Health Plan1351365,940 · 4th of 51276
LouisianaCovers none for weight loss137138Ozempic: covered · Mounjaro: covered139140Not covered · Office of Group Benefits1411424,962 · 9th of 51276
MaineCovers none for weight loss143144Ozempic: non-preferred · Mounjaro: not confirmed145146Covered, with conditions · State of Maine Health Plan1471482,916 · 20th of 51276
MarylandCovers none for weight loss149150Ozempic: preferred · Mounjaro: preferred151Not covered · State Employee and Retiree Health and Welfare Benefits Program1521532,318 · 26th of 51276
MassachusettsCovers none for weight loss154155Ozempic: preferred · Mounjaro: preferred156157Not covered · GIC1585,575 · 5th of 51276
MontanaCovers none for weight loss159160Ozempic: preferred · Mounjaro: non-preferred161162Not covered · State of Montana Benefit Plan1631641,961 · 33rd of 51276
NebraskaCovers none for weight loss165166Ozempic: preferred · Mounjaro: non-preferred167168Not covered · State of Nebraska employee health plan1691701,844 · 35th of 51276
NevadaCovers none for weight loss171172Ozempic: preferred · Mounjaro: preferred173174Not covered · Nevada Public Employees' Benefits Program1751762,101 · 29th of 51276
New HampshireCovers none for weight loss177178Ozempic: preferred · Mounjaro: non-preferred179180Not covered · State of New Hampshire Health Benefit Plan1812,423 · 25th of 51276
New JerseyCovers none for weight loss182183Ozempic: not confirmed · Mounjaro: not confirmed184183Covered, with conditions · New Jersey State Health Benefits Program1851861,344 · 41st of 51276
New MexicoCovers none for weight loss187188Ozempic: not confirmed · Mounjaro: not confirmed189190Not confirmed · State of New Mexico State Health Benefits1911923,008 · 19th of 51276
New YorkCovers none for weight loss193194Ozempic: preferred · Mounjaro: non-preferred195196Covered, with conditions · NYSHIP Empire Plan1971984,053 · 14th of 51276
North DakotaCovers none for weight loss199200Ozempic: preferred · Mounjaro: preferred201202Not covered · NDPERS Dakota Plan203204380 · 51st of 51276
OhioCovers none for weight loss205206Ozempic: non-preferred · Mounjaro: non-preferred207208Not covered · Ohio Med2092103,534 · 17th of 51276
OklahomaCovers none for weight loss211212Ozempic: non-preferred · Mounjaro: non-preferred213214Not confirmed · HealthChoice2152161,960 · 34th of 51276
OregonCovers none for weight loss217218Ozempic: non-preferred · Mounjaro: non-preferred219220Not covered · PEBB2212221,488 · 39th of 51276
PennsylvaniaCovers none for weight loss223224Ozempic: preferred · Mounjaro: non-preferred225226Not confirmed6,451 · 2nd of 51276
Rhode IslandCovers none for weight loss227228Ozempic: preferred · Mounjaro: non-preferred229230Not confirmed · State of Rhode Island employee medical plans2314,172 · 13th of 51276
South CarolinaCovers none for weight loss232233Ozempic: preferred · Mounjaro: non-preferred234235Not covered · State Health Plan2362371,166 · 43rd of 51276
South DakotaCovers none for weight loss238239Ozempic: preferred · Mounjaro: preferred238240Not confirmed · South Dakota State Employee Health Plan2411,651 · 38th of 51276
UtahCovers none for weight loss248249Ozempic: preferred · Mounjaro: preferred250251Not covered · PEHP252253775 · 44th of 51276
VermontCovers none for weight loss254255Ozempic: preferred · Mounjaro: preferred256Not confirmed · State of Vermont employee medical plans2572582,662 · 23rd of 51276
WashingtonCovers none for weight loss259260Ozempic: preferred · Mounjaro: non-preferred261262Not covered · PEBB Uniform Medical Plan263264750 · 45th of 51276
West VirginiaCovers none for weight loss265266Ozempic: preferred · Mounjaro: non-preferred267Not covered · West Virginia Public Employees Insurance Agency2682695,346 · 6th of 51276
WyomingCovers none for weight loss270271Ozempic: non-preferred · Mounjaro: non-preferred272273Covered, with conditions · State of Wyoming Employees' Group Insurance274275384 · 50th of 51276

Prescriptions: CMS State Drug Utilization Data, divided by each state's residents. Every state, ranked

  • * Virginia: BMI over 40 with no listed risk factor, or BMI over 37 with dyslipidemia, high blood pressure or type 2 diabetes.

If Medicaid doesn’t cover it: our top-rated programs

In 38 of the 51 states we checked, Medicaid covers no GLP-1 for weight loss. These are the three programs ranked highest on our score. Check that a program ships to your state before you sign up.

See the full ranking

We may earn a commission when you sign up through some links. It never changes our order or scores. How we make money

  1. WellMedr 9.6/10
    Ships to every state and DC
    $41/moVisit site of WellMedr
  2. Embody 9.6/10
    Not available in District of Columbia and Louisiana
    $53/moVisit site of Embody
  3. Collective 9.3/10
    Not available in 7 states
    $76/moVisit site of Collective

Why don’t more states’ Medicaid programs cover GLP‑1s for weight loss?

Federal law lets each state choose: SSA §1927(d)(1)(B)(ii) allows a state to exclude or restrict coverage of drugs on the §1927(d)(2) list, and §1927(d)(2)(A) lists 'agents when used for anorexia, weight loss, or weight gain'. A state may therefore cover GLP-1s for weight loss or exclude them; drugs for other medically accepted indications (e.g., type 2 diabetes) are not on that list. The BALANCE Model adds a voluntary route for states to cover them on CMS-negotiated terms.277278

Will more states’ Medicaid cover Wegovy or Zepbound? The BALANCE model

Open to all states, DC and territories in the Medicaid Drug Rebate Program. States applied through the State Medicaid RFA (released March 9, 2026; due July 31, 2026) and execute a State Agreement with CMS; each state picks a start date between May 1, 2026 and January 1, 2027. States that do not join by January 1, 2027 may be allowed to join at CMS discretion. Medicaid Key Terms (confidential) are effective through December 31, 2027. Model beneficiaries receiving a model drug for weight management must be 18+.283284285

CMS has not named the states that joined.

DateWhat happened
December 23, 2025CMS announces the BALANCE Model and a Medicare GLP-1 payment demonstration282
March 9, 2026State Medicaid Request for Applications released283
May 1, 2026Earliest Medicaid start; states start on a date of their choosing through Jan 1, 2027284279
July 1, 2026Medicare GLP-1 Bridge begins ($50 copay, outside Part D)286287
July 31, 2026Deadline for state applications to the State Medicaid RFA283
January 1, 2027Last day for states to execute a State Agreement; later joining at CMS discretion. Originally the Part D launch date, now not launching in 2027283285280
December 31, 2027Medicare GLP-1 Bridge ends (extended); Medicaid Key Terms effective through this date280288
December 1, 2031Model runs through December 2031284

Does Medicare cover GLP‑1s for weight loss?

Part D still excludes drugs used for weight loss alone: the Part D drug definition excludes drugs and uses Medicaid may exclude under SSA §1927(d)(2), which lists agents used for weight loss. Part D plans can cover GLP-1s for type 2 diabetes, MACE risk reduction (Wegovy), moderate-to-severe obstructive sleep apnea (Zepbound) and noncirrhotic MASH with fibrosis (Wegovy). For weight loss alone, the Medicare GLP-1 Bridge demonstration (July 1, 2026 – Dec 31, 2027) gives eligible Part D enrollees Foundayo, Wegovy or Zepbound KwikPen for a $50 monthly copay, outside the Part D benefit. The BALANCE Model's Part D component is not launching in 2027.289277290291286287280292

What GLP‑1s cost without insurance, in any state

Where Medicaid or a plan does not cover them, the makers sell the brand-name drugs for cash, with a prescription, at the same price in every state. These are standing prices: a lower offer applies to some first fills.

DrugSellerCash price a month, by dose
FoundayoLillyDirect$149 to $299293294295
Wegovy pillNovoCare Pharmacy$149 to $299296297
ZepboundLillyDirect$299 to $449298299300301
OzempicNovoCare Pharmacy$349 to $499302303
WegovyNovoCare Pharmacy$349304297
MounjaroLillyDirect$499305

The lowest price among the online programs that ship to every state is WellMedr: $492 for 12 months ($41 a month); $99 month to month, fees in.306 Includes a sale seen on November 5, 2026; the price returns to the standing price when it ends.

We may earn a commission when you sign up through some links. It never changes our order or scores. How we make money

WellMedr’s site
Questions

GLP‑1 coverage by state: questions

Medicaid covers Wegovy and Zepbound for weight loss in 8 of the 51 states we checked, with prior authorization: Delaware, Kansas, Michigan, Minnesota, Mississippi, North Carolina, Tennessee and Virginia. 5 more cover some GLP-1s, or for some people only. 38 cover none for weight loss.

It depends on the state: federal law lets each state choose whether to cover drugs for weight loss. Of the 51 states we checked, 8 cover Wegovy for weight loss: Delaware, Kansas, Michigan, Minnesota, Mississippi, North Carolina, Tennessee and Virginia; 2 more cover it for some people only.

It depends on the state: federal law lets each state choose whether to cover drugs for weight loss. Of the 51 states we checked, 10 cover Zepbound for weight loss: Delaware, Kansas, Michigan, Minnesota, Mississippi, North Carolina, Tennessee, Virginia, Missouri and Wisconsin.

For type 2 diabetes, 46 of the 51 states we checked list Ozempic on their Medicaid drug lists.

Open to all states, DC and territories in the Medicaid Drug Rebate Program. States applied through the State Medicaid RFA (released March 9, 2026; due July 31, 2026) and execute a State Agreement with CMS; each state picks a start date between May 1, 2026 and January 1, 2027. States that do not join by January 1, 2027 may be allowed to join at CMS discretion. Medicaid Key Terms (confidential) are effective through December 31, 2027. Model beneficiaries receiving a model drug for weight management must be 18+.

Part D still excludes drugs used for weight loss alone: the Part D drug definition excludes drugs and uses Medicaid may exclude under SSA §1927(d)(2), which lists agents used for weight loss. Part D plans can cover GLP-1s for type 2 diabetes, MACE risk reduction (Wegovy), moderate-to-severe obstructive sleep apnea (Zepbound) and noncirrhotic MASH with fibrosis (Wegovy). For weight loss alone, the Medicare GLP-1 Bridge demonstration (July 1, 2026 – Dec 31, 2027) gives eligible Part D enrollees Foundayo, Wegovy or Zepbound KwikPen for a $50 monthly copay, outside the Part D benefit. The BALANCE Model's Part D component is not launching in 2027.

The makers’ cash prices are the same in every state: Foundayo from $149 a month at LillyDirect, Wegovy pill from $149 a month at NovoCare Pharmacy, Zepbound from $299 a month at LillyDirect, Ozempic from $349 a month at NovoCare Pharmacy, Wegovy from $349 a month at NovoCare Pharmacy and Mounjaro from $499 a month at LillyDirect, with a prescription.

  1. 1.
    2026 Delaware Medicaid Preferred Drug List (PDL), effective Nov. 2, 2026Nutritional Products, Obesity Treatment Agents (p. 41)Delaware Medical Assistance Program (DMAP)retrieved 2026-11-10↩“(Clinical criteria applies to class. All agents require a prior authorization.)”
  2. 2.
    Request for Medication Prior Authorization: GLP-1 Agonist for Weight Management, MASH or Prevention of MACE (revised April 20, 2026)Page 1, Initial Criteria – Weight LossDelaware Medical Assistance Program (DMAP)retrieved 2026-11-10↩“For adult member – body mass index (BMI) ≥ 30 kg/m2”
  3. 3.
    2026 Delaware Medicaid Preferred Drug List (PDL), effective Nov. 2, 2026Hypoglycemics, Incretin Mimetics/Enhancers: GLP-1 RAs (p. 27)Delaware Medical Assistance Program (DMAP)retrieved 2026-11-10↩“Two (2) preferred products required before a non-preferred product will be approved.”
  4. 4.
    Weight Loss Medications FAQs (updated July 29, 2026)IntroductionState of Delaware Statewide Benefits Officeretrieved 2026-11-10↩“the Committee voted to increase the copay to $200 per 30-day supply for GLP-1 medications for weight management, such as Wegovy and Zepbound, effective July 1, 2026 for non-Medicare prescription plan participants.”
  5. 5.
    Weight Loss Medications FAQs (updated July 29, 2026)Question 5 (diabetes) and question 7 (Zepbound clinical exception)State of Delaware Statewide Benefits Officeretrieved 2026-11-10↩“Individuals with a diabetes diagnosis who are prescribed a GLP-1 medication in the diabetes class will continue to pay the $32 copay per 30-day supply.”
  6. 6.
    KMAP General Bulletin 23255 (posted Oct. 6, 2023)Bulletin textKansas Medical Assistance Program, as posted by Sunflower Health Plan (KanCare)retrieved 2026-11-10↩“coverage for anti-obesity medication (AOM) will include all AOMs that are rebate eligible.”
  7. 7.
    KMAP General Bulletin 24071: Preferred Drug List update (posted April 17, 2024)Bulletin textKansas Medical Assistance Program, as posted by Sunflower Health Plan (KanCare)retrieved 2026-11-10↩“Effective on and after April 1, 2024, the following medication is now PDL preferred: Zepbound (Tirzepatide)”
  8. 8.
    KMAP General Bulletin 23054: Clinical prior authorization update (posted March 14, 2023)Medications requiring Clinical PA from March 18, 2023Kansas Medical Assistance Program, as posted by Sunflower Health Plan (KanCare)retrieved 2026-11-10↩“Tirzepatide (Mounjaro) Pen”
  9. 9.
    KMAP General Bulletin 23184: Preferred Drug List update (posted July 6, 2023)Medications now preferredKansas Medical Assistance Program, as posted by Sunflower Health Plan (KanCare)retrieved 2026-11-10↩“The following medications are now preferred and a PDL PA is no longer required: • Semaglutide (Ozempic®) Pen”
  10. 10.
    GLP-1sCoverage Thru the Health Plan Starting January 1stKansas State Employee Health Planretrieved 2026-11-10↩“Patients must have a Body Mass Index (BMI) of 35 or higher to qualify for coverage of GLP-1s for weight management.”
  11. 11.
    Numbered Letter L 25-73: Update of Pharmacy Drug Coverage for Treatment of ObesityEffective for Dates of Service On or After January 1, 2026 (letter dated December 8, 2025)Michigan Department of Health and Human Servicesretrieved 2026-11-10↩“Coverage of GLP-1 medications when prescribed solely to treat obesity, including requests for continuation, will be reduced.”
  12. 12.
    Michigan Preferred Drug List (PDL)/Single PDL, Effective November 1, 2026Drug Class: Anti-Obesity/Weight Loss Agents, Non-Preferred Agents (p. 102)Prime Therapeutics for MDHHSretrieved 2026-11-10↩“NON-PREFERRED AGENTS ... Foundayo (orforglipron calcium) ... Wegovy tablet (semaglutide) ... Zepbound (tirzepatide)”
  13. 13.
    Michigan Preferred Drug List (PDL)/Single PDL, Effective November 1, 2026: Incretin MimeticsDiabetes, Drug Class: Incretin Mimetics (p. 53)Prime Therapeutics for MDHHSretrieved 2026-11-10↩“PREFERRED AGENTS Mounjaro Ozempic injectable Trulicity Victoza NON-PREFERRED AGENTS Bydureon Bcise exenatide liraglutide Ozempic tablets Rybelsus”
  14. 14.
    Michigan Medicaid Clinical and PDL Criteria: Diabetes: Incretin Mimetics and CombinationsDiabetes: Incretin Mimetics and Combinations, Criteria to Approve (p. 148)Prime Therapeutics for MDHHSretrieved 2026-11-10↩“CLINICAL PA CRITERIA FOR PREFERRED AGENTS Diagnosis of type 2 diabetes”
  15. 15.
    Insurance Plans: Health and Prescription Drug PlansState Health Plan PPO: medical and prescription drug administratorsMichigan Civil Service Commission (MDCS), Employee Benefitsretrieved 2026-11-10↩“Optum Rx (SHP PPO) www.optumrx.com/SOM”
  16. 16.
    2026 Premium Standard Formulary, Effective July 1, 2026 (State of Michigan active employees and non-Medicare retirees)Drug tiers legend (p. 3) and entries for WEGOVY, WEGOVY HD, ZEPBOUND, SAXENDA, FOUNDAYOOptum Rx for the State of Michiganretrieved 2026-11-10↩“Tier E Excluded May not be covered or need prior authorization. Lower-cost options are available and covered.”
  17. 17.
    Anti-Obesity Medications (prior authorization criteria, November 2026)Initial approval criteria, baseline BMIMinnesota Department of Human Servicesretrieved 2026-11-10↩“Greater than or equal to 30 kg/m2 with no risk factors (for patient at least 18 years of age)”
  18. 18.
    Anti-Obesity Medications (prior authorization criteria, November 2026)Covered drugs with prior authorization (list includes Foundayo, liraglutide, Saxenda, Wegovy, Xenical and Zepbound)Minnesota Department of Human Servicesretrieved 2026-11-10↩“Covered drugs with prior authorization:”
  19. 19.
    Minnesota Fee-for-Service and Managed Care Medicaid Uniform Preferred Drug List (effective August 4, 2026)Hypoglycemics, Incretin Mimetics/Enhancers (Preferred: Ozempic, Trulicity, Victoza; Nonpreferred: Mounjaro, Rybelsus, liraglutide)Minnesota Department of Human Servicesretrieved 2026-11-10↩“HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS section updated 4-1-2026”
  20. 20.
    Drug Formulary Committee meeting minutes, July 15, 2026 (draft)New business, Hypoglycemics, Incretin Mimetics/EnhancersMinnesota Department of Human Servicesretrieved 2026-11-10↩“MOUNJARO (SUBCUTANE.) to be moved on the PDL to PREFERRED.”
  21. 21.
    2027 Open Enrollment booklet: Former Employees with Disabilities (FEWD)Prescription Drugs, p. 9Minnesota Management and Budget, State Employee Group Insurance Program (SEGIP)retrieved 2026-11-10↩“CVS Caremark manages the prescription drug benefit that’s part of the Minnesota Advantage Health Plan.”
  22. 22.
    Universal Preferred Drug List, effective 11/1/2026 (version 2026_17, updated 10/29/2026)Antiobesity Select Agents (p. 17)Mississippi Division of Medicaidretrieved 2026-11-10↩“All agents MANUAL PA required”
  23. 23.
    State Plan Amendment MS-23-0013, Attachment 3.1-A, Exhibit 12A, Page 1 (Drugs to Treat Obesity)12a. Prescribed Drugs, item (5) footnote; Date Effective 07/01/2023 (Internet Archive copy, Feb. 14, 2026)Mississippi Division of Medicaidretrieved 2026-11-10↩“*Coverage is limited to selected drugs that treat obesity.”
  24. 24.
    Universal Preferred Drug List, effective 11/1/2026 (version 2026_17, updated 10/29/2026)Hypoglycemics, Incretin Mimetics/Enhancers (p. 40)Mississippi Division of Medicaidretrieved 2026-11-10↩“No history of GLP-1 agonist therapy for obesity in the past 30 days”
  25. 25.
    Mississippi's State and School Employees' Life and Health Insurance Plan Document, Revised 1/1/2026Prescription Drug Program: Wegovy and Zepbound (p. 33)Mississippi Department of Finance and Administrationretrieved 2026-11-10↩“Wegovy and other drugs used for weight loss and/or obesity are a plan exclusion.”
  26. 26.
    Mississippi's State and School Employees' Life and Health Insurance Plan Document, Revised 1/1/2026Pharmacy Benefit Manager (p. 4) and Limitations and Exclusions (p. 34)Mississippi Department of Finance and Administrationretrieved 2026-11-10↩“Weight loss drugs are not covered.”
  27. 27.
    North Carolina Medicaid Preferred Drug List (PDL), Effective Date October 1, 2026 (revised 09.21.2026)Weight Management Agents: GLP-1 Receptor Agonists indicated for the treatment of obesity (Incretin Mimemetics) — Preferred column: Wegovy® Pen/Tablet, Wegovy® HD Pen, Foundayo™ Tablet, Zepbound® (tirzepatide) Pen/Kwikpen; Non-Preferred column: liraglutide Pen/5-pak (generic Saxenda®), Saxenda® (liraglutide) Pen. Diabetes class — Preferred: Byetta® Pen, Mounjaro™ Pen, Ozempic® Pen, Trulicity® Pen, Victoza Pen; Non-Preferred: Bydureon® BCise™, exenatide Pen, liraglutide pen, Ozempic® Tablet, Rybelsus® Tablet, Soliqua® Pen, Xultophy® PenNC DHHS Division of Health Benefitsretrieved 2026-11-09↩“Clinical criteria apply to all drugs in this class”
  28. 28.
    North Carolina Medicaid Preferred Drug List (PDL), Effective Date October 1, 2026, revision notePage header revision notesNC DHHS Division of Health Benefitsretrieved 2026-11-09↩“Revised 09.14.2026 Removed Zepbound® (tirzepatide) Vial in the GLP-1 Receptor Agonists indicated for the treatment of obesity (Incretin Mimemetics) effective 09.04.2026”
  29. 29.
    NC Medicaid Pharmacy Newsletter, Number 393, September 2026Oct. 1, 2026 Preferred Drug List (PDL) Changes: Endocrinology; MiscellaneousNC DHHS Division of Health Benefitsretrieved 2026-11-09↩“Weight Management Agents o Wegovy HD, Foundayo Tablet added to Preferred o Zepbound Pen/KwikPen moved to Preferred”
  30. 30.
    Treasurer Folwell and State Health Plan Issue Request for Information on GLP-1 Drugs (April 22, 2024)Press release bodyNC Department of State Treasurerretrieved 2026-11-09↩“In January, the State Health Plan Board of Trustees (Board) voted to end coverage of popular GLP-1 drugs like Wegovy and Saxenda for the purpose of weight loss starting on April 1, 2024, citing their high cost.”
  31. 31.
    North Carolina Department of State Treasurer Announces Successful Negotiation with CVS Caremark (Oct. 7, 2025)Press release bodyNC Department of State Treasurerretrieved 2026-11-09↩“Additionally, this agreement gives the Plan the ability to negotiate directly with manufacturers of GLP-1s to potentially restore coverage of weight-loss medications to members.”
  32. 32.
    Provider Notice: TennCare Pharmacy Coverage of Obesity Management Agents (08/01/25)Page 1, TennCare Pharmacy Coverage of Obesity Management AgentsDivision of TennCare and Optum Rxretrieved 2026-11-10↩“The following will be considered preferred with PA: WEGOVY PA, QL, ZEPBOUND PA, QL.”
  33. 33.
    TennCare: Preferred Drug List (PDL), effective November 2, 2026XIX. Weight Management Agents, GLP-1 Weight Management Agents (Preferred: Wegovy injection, Zepbound single dose prefilled pen; Non-Preferred: liraglutide, Saxenda)Division of TennCare and Optum Rxretrieved 2026-11-10↩“Saxenda® injection PA, QL”
  34. 34.
    TennCare: Preferred Drug List (PDL), effective November 2, 2026GLP-1 Agonists (Preferred: Mounjaro inj, Ozempic inj, Soliqua inj, Wegovy inj, Zepbound pen; Non-Preferred: exenatide, liraglutide, Ozempic tabs, Rybelsus tabs, Trulicity inj, Victoza inj, Wegovy tablets, Xultophy, Zepbound KwikPen)Division of TennCare and Optum Rxretrieved 2026-11-10↩“Trulicity® inj PA, QL”
  35. 35.
    Prior Authorization Form: GLP-1 Agonists (revision 10/2026)Page 2, question 7 (Type 2 Diabetes)Division of TennCare and Optum Rxretrieved 2026-11-10↩“HbA1c greater than or equal to 6.5%”
  36. 36.
    State Plan Document 2026 (State of Tennessee Group Health Insurance Plan)Part I, Covered Expenses, item (R)State of Tennessee, Partners for Health / Benefits Administrationretrieved 2026-11-10↩“Certain preferred anti-obesity medications (as determined by the Pharmacy Benefits Manager), subject to Prior Authorization.”
  37. 37.
    Pharmacy Benefits & CVS Caremark CoveragePharmacy BenefitsState of Tennessee, Partners for Healthretrieved 2026-11-10↩“All Partners for Health medical plans include pharmacy benefits, managed by CVS Caremark.”
  38. 38.
    Virginia's Medicaid Preferred Drug List (PDL)/Common Core Formulary, effective 10/1/26 (version 3)Weight Management Agents CLOSED CLASS (p. 55): non-preferred column lists Foundayo, Imcivree, liraglutide, Lomaira, phentermine/topiramate ER, Saxenda, Wegovy, Wegovy HD, ZepboundVirginia Department of Medical Assistance Services (Prime Therapeutics)retrieved 2026-11-10↩“♦ The selected GLP-1 Receptor Agonist is injectable brand Wegovy, excluding the high dose formulation”
  39. 39.
    Virginia's Medicaid Preferred Drug List (PDL)/Common Core Formulary, effective 10/1/26 (version 3)General InformationVirginia Department of Medical Assistance Services (Prime Therapeutics)retrieved 2026-11-10↩“Non-preferred drugs require a SA”
  40. 40.
    Virginia's Medicaid Preferred Drug List (PDL)/Common Core Formulary, effective 10/1/26 (version 3)Diabetes Hypoglycemics: Injectable and Oral Incretin Mimetics CLOSED CLASS (p. 48): preferred Trulicity, Victoza; non-preferred exenatide, liraglutide, Mounjaro, Ozempic, Rybelsus, Soliqua, Tanzeum, XultophyVirginia Department of Medical Assistance Services (Prime Therapeutics)retrieved 2026-11-10↩“Diagnosis of type II diabetes”
  41. 41.
    Virginia DMAS SA Form: Non-Preferred Incretin Mimetics (revised 03/21/2024)Diagnosis and medical information, p. 2Virginia Department of Medical Assistance Servicesretrieved 2026-11-10↩“Has the member tried and failed an adequate trial of 2 different preferred products?”
  42. 42.
    Health Benefits E-News, August 12, 2026: Updated Weight Loss GLP-1 Prior Authorization CriteriaUpdated Weight Loss GLP-1 Prior Authorization Criteria (New Users and Existing Users)Virginia Department of Human Resource Management, Office of State Health Benefitsretrieved 2026-11-10↩“Any initial authorization request for GLP 1 therapy for weight loss submitted on or after July 1, 2026 must meet the new PA criteria”
  43. 43.
    Getting the most from your COVA Care Plan, July 1, 2026 through June 30, 2027Prescription drug benefitsVirginia Department of Human Resource Managementretrieved 2026-11-10↩“through Anthem Pharmacy delivered by CarelonRx”
  44. 44.
    Indiana Medicaid Statewide Uniform Preferred Drug List (SUPDL), effective Aug. 1, 2026Indiana Health Coverage Programs (IHCP) Drug Coverage, exclusions (p. 1)Optum Rx for Indiana FSSA / Indiana Health Coverage Programsretrieved 2026-11-10↩“Anorectics or any agent used to promote weight loss”
  45. 45.
    Criteria for Indiana Medicaid: GLP-1 Receptor Agonists and Combinations (07.01.2026)Non-Preferred Agents: Wegovy (semaglutide) injection formulation, initial authorizationOptum Rx for State of Indianaretrieved 2026-11-10↩“WEGOVY (SEMAGLUTIDE) INJECTION FORMULATION (NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS)”
  46. 46.
    Indiana Medicaid Statewide Uniform Preferred Drug List (SUPDL), effective Aug. 1, 2026Endocrine: GLP-1 Receptor Agonists and Combinations (p. 39), preferred and non-preferred columnsOptum Rx for Indiana FSSA / Indiana Health Coverage Programsretrieved 2026-11-10↩“Effective for FFS and Managed Care Organization claims submitted on or after August 1, 2026.”
  47. 47.
    Benefits: Prescription CoverageGLP-1 Drugs for Weight LossIndiana State Personnel Departmentretrieved 2026-11-10↩“Effective January 1, 2026, GLP-1 drugs used for weight loss will no longer be covered under the State’s pharmacy benefit.”
  48. 48.
    The Torch, Open Enrollment Edition (2027 plan year)Prescription drug coverage (p. 5) and Health Plan Options (p. 4)Indiana State Personnel Departmentretrieved 2026-11-10↩“CVS Caremark is the Pharmacy Benefit Manager (PBM) for the State.”
  49. 49.
    SmartPA Criteria Proposal: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit (revised April 23, 2026)Executive Summary, Why Issue SelectedMO HealthNet Division and Conduentretrieved 2026-11-10↩“MO HealthNet is beginning coverage for select anti-obesity agents.”
  50. 50.
    SmartPA Criteria Proposal: GLP-1 Receptor Agonists Indicated for Obesity PDL Edit (revised April 23, 2026)Executive Summary, Preferred and Non-Preferred AgentsMO HealthNet Division and Conduentretrieved 2026-11-10↩“Medications indicated only for anti-obesity but not listed within this policy remain excluded from MO HealthNet coverage.”
  51. 51.
    SmartPA Criteria Proposal: GLP-1 Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit (revised July 23, 2026)Executive Summary, Preferred and Non-Preferred AgentsMO HealthNet Division and Conduentretrieved 2026-11-10↩“Preferred Agents: Mounjaro® Ozempic® Inj Trulicity® Victoza Non-Preferred Agents: Byetta® Exenatide Liraglutide (gen Victoza®) Rybelsus® Soliqua® Xultophy®”
  52. 52.
    SmartPA Criteria Proposal: GLP-1 Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit (revised January 29, 2026)Approval CriteriaMO HealthNet Division and Conduentretrieved 2026-11-10↩“Additional approval criteria for Mounjaro: Clinical consultant review for reason of medical necessity why Zepbound® cannot be utilized.”
  53. 53.
    Pharmacy Plan: State EmployeesPharmacy Plan introductionMissouri Consolidated Health Care Planretrieved 2026-11-10↩“All medical coverage includes MCHCP’s prescription drug benefits, administered by Express Scripts.”
  54. 54.
    ForwardHealth Update No. 2026-15: July 2026 Preferred Drug List Changes and Other Pharmacy PolicyNew Weight Management Agents Drug Class (p. 3)Wisconsin Department of Health Services, ForwardHealthretrieved 2026-11-10↩“Foundayo and Zepbound will become preferred drugs in the weight management agents drug class.”
  55. 55.
    ForwardHealth Update No. 2026-15: July 2026 Preferred Drug List Changes and Other Pharmacy PolicyNew Weight Management Agents Drug Class (p. 3)Wisconsin Department of Health Services, ForwardHealthretrieved 2026-11-10↩“PA will be required for all weight management agents, including preferred weight management agents.”
  56. 56.
    ForwardHealth Update No. 2026-15: July 2026 Preferred Drug List Changes and Other Pharmacy PolicyChanges to Hypoglycemics, Glucagon-Like Peptide Drug Class (p. 27)Wisconsin Department of Health Services, ForwardHealthretrieved 2026-11-10↩“Mounjaro will become a preferred drug in the hypoglycemics, glucagon-like peptide drug class.”
  57. 57.
    Wisconsin Medicaid, BadgerCare Plus Standard, and SeniorCare Preferred Drug List – Quick Reference (effective 11/01/2026)Hypoglycemics, GLP 1 (preferred: liraglutide, Byetta, Mounjaro pen, Ozempic subQ, Soliqua, Trulicity, Victoza; non-preferred: exenatide, Ozempic tablet, Rybelsus tablets, Xultophy)Wisconsin Department of Health Services, ForwardHealthretrieved 2026-11-10↩“Rybelsus tablets DR NP”
  58. 58.
    2027 Non-Medicare Plan Design and Cost-Sharing Changes2027 Non-Medicare Benefit and Plan Design Changes, introductionWisconsin Department of Employee Trust Fundsretrieved 2026-11-10↩“the Board approved the coverage of anti-obesity medications (AOMs), also known as GLP-1s, for non-Medicare members.”
  59. 59.
    2027 Non-Medicare Plan Design and Cost-Sharing ChangesPharmacy cost-sharing table, 2027 and 2026 columnsWisconsin Department of Employee Trust Fundsretrieved 2026-11-10↩“Anti-Obesity Medications $200 Not covered”
  60. 60.
    Alabama Medicaid Agency Preferred Drug List (PDL) Reference Tool (effective 10/01/2026)Diabetic Agents, Incretin Mimetics (p. 14)Alabama Medicaid Agencyretrieved 2026-11-10↩“Zepbound is non-covered for weight reduction without OSA.”
  61. 61.
    Alabama Medicaid Agency Preferred Drug List (PDL) Reference Tool (effective 10/01/2026)Diabetic Agents, Incretin Mimetics, Wegovy note (p. 14)Alabama Medicaid Agencyretrieved 2026-11-10↩“Wegovy is non-covered for weight reduction.”
  62. 62.
    Alabama Medicaid Agency Preferred Drug List (PDL) Reference Tool (effective 10/01/2026)Incretin Mimetics, Preferred Brand column (Byetta, Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza marked CC) and page legendAlabama Medicaid Agencyretrieved 2026-11-10↩“ccDenotes agent is preferred with clinical criteria in place.”
  63. 63.
    The State Employees' Health Insurance Plan, State of Alabama (effective January 1, 2026)Chapter 17, Prescription Drug Benefits (p. 49)State Employees' Insurance Board and Blue Cross and Blue Shield of Alabamaretrieved 2026-11-10↩“The drug lists are also available at www.MyPrime.com.”
  64. 64.
    The State Employees' Health Insurance Plan, State of Alabama (effective January 1, 2026)Exclusions, OState Employees' Insurance Board and Blue Cross and Blue Shield of Alabamaretrieved 2026-11-10↩“Unless otherwise expressly covered under this Plan, services or expenses for treatment of any condition including, but not limited to, obesity, diabetes, or heart disease, that is based upon weight reduction or dietary control.”
  65. 65.
    Clinical Criteria for Use: Ozempic, Wegovy (semaglutide), Version 2, updated 09/18/2026Approval Criteria, Wegovy injection and Wegovy tabletsAlaska Medicaid (Alaska Department of Health)retrieved 2026-11-10↩“Patient has a Body Mass Index (BMI) ≥ 25 and documented diagnosis of one or more of the following”
  66. 66.
    Clinical Criteria for Use: Ozempic, Wegovy (semaglutide), Version 2, updated 09/18/2026Denial Criteria, item 2Alaska Medicaid (Alaska Department of Health)retrieved 2026-11-10↩“being prescribed for purposes of weight control (excluded from coverage under Alaska Administrative Code 7 AAC 105.110 and 7 AAC 120.112)”
  67. 67.
    Alaska Medicaid Preferred Drug List, effective 11/01/2026Hypoglycemics, Incretin Mimetics/Enhancers (PDL status column)Alaska Department of Healthretrieved 2026-11-10↩“MOUNJARO (SUBCUTANE.) SSB TIRZEPATIDE 10MG/0.5ML OFF 11/1/2026 NO CHANGE”
  68. 68.
    Alaska Medicaid PDL LegendStatus of Drug column keyAlaska Department of Healthretrieved 2026-11-10↩“"ON" = Preferred "OFF" - Non-Preferred”
  69. 69.
    AlaskaCare Employee Health Plans: Nutrition Program | VirtaNutrition Program | VirtaState of Alaska, Division of Retirement and Benefitsretrieved 2026-11-10↩“Effective January 1, 2026, the AlaskaCare Employee Health Plan implemented a weight loss program managed by Virta in conjunction with Optum Rx”
  70. 70.
    AlaskaCare Employee Health Plan 2027 Open Enrollment Guide (November 2026)Benefit Highlights, Weight Loss Program for GLP-1 UtilizersState of Alaska, Division of Retirement and Benefitsretrieved 2026-11-10↩“You will only be able to fill a GLP-1 prescription for weight loss that has been prescribed by a Virta Health provider.”
  71. 71.
    AMPM Policy 310-V: Prescription Medications/Pharmacy ServicesSection J, AHCCCS Pharmacy Benefit Exclusions, item 9Arizona Health Care Cost Containment System (AHCCCS)retrieved 2026-11-10↩“Medications used for weight loss treatment.”
  72. 72.
    AHCCCS Fee-For-Service Prior Authorization Guidelines (Optum Rx), effective November 1, 2026: Wegovy (semaglutide), GL-509188Wegovy (semaglutide) guideline, effective 2/1/2026, Diagnosis: Weight Loss (p. 2012)AHCCCS and Optum Rxretrieved 2026-11-10↩“Wegovy when used for the treatment of weight loss is excluded and is to be denied as a benefit exclusion”
  73. 73.
    AHCCCS Fee-For-Service Prior Authorization Guidelines (Optum Rx), effective November 1, 2026: GLP-1 Agonists - AZM, GL-749236GLP-1 Agonists - AZM, product groups (pp. 717-721)AHCCCS and Optum Rxretrieved 2026-11-10↩“Product Name:Preferred Drugs: Mounjaro, Trulicity, Brand Victoza, generic liraglutide”
  74. 74.
    AHCCCS Fee-For-Service Prior Authorization Guidelines (Optum Rx), effective November 1, 2026: GLP-1 Agonists - AZM, GL-749236GLP-1 Agonists - AZM, non-preferred product groups (pp. 718-721)AHCCCS and Optum Rxretrieved 2026-11-10↩“Product Name:Non-Preferred: Ozempic tablets, Rybelsus”
  75. 75.
    State of Arizona Benefit Options 2027 Benefits Enrollment Guide (Active Employees)Prescription Drug Plan (p. 8)Arizona Department of Administration, Benefit Services Division (hosted by Delta Dental of Arizona)retrieved 2026-11-10↩“MedImpact is the prescription drug provider for both medical plans and is included in your coverage.”
  76. 76.
    Arkansas Medicaid Clinical Criteria (Prior Authorization Criteria), revised October 1, 2026Semaglutide Injection and Oral Tablet (Wegovy), updated 10/15/2025, p. 540Arkansas Medicaid Pharmacy Program and Prime Therapeuticsretrieved 2026-11-10↩“Note: Arkansas Medicaid does not currently cover medications solely for the use of weight loss.”
  77. 77.
    Arkansas Medicaid Clinical Criteria (Prior Authorization Criteria), revised October 1, 2026Tirzepatide 10 mg and 15 mg Injection (Zepbound) – OSA Only, updated 4/16/2025, p. 603Arkansas Medicaid Pharmacy Program and Prime Therapeuticsretrieved 2026-11-10↩“Arkansas Medicaid does not cover medications solely for weight loss. The criteria listed below pertain to the obstructive sleep apnea indication only.”
  78. 78.
    Arkansas Medicaid Preferred Drug List (PDL), effective October 1, 2026Antidiabetic Agents – GLP-1 Receptor Agonists (updated 06/01/2025), preferred agentsArkansas Medicaid Pharmacy Program and Prime Therapeuticsretrieved 2026-11-10↩“VICTOZA (liraglutide)* – BRAND ONLY”
  79. 79.
    Arkansas Medicaid Clinical Criteria (Prior Authorization Criteria), revised October 1, 2026Antidiabetic agents, GLP-1 Agonists, approval criteria for preferred GLP-1 agonists, p. 52Arkansas Medicaid Pharmacy Program and Prime Therapeuticsretrieved 2026-11-10↩“Medicaid pharmacy profile indicates a paid claim in the last 60 days for a preferred GLP-1 receptor agonist”
  80. 80.
    2026 ARBenefits Summary Plan Document for Arkansas State Employees and Arkansas Public School Employees with Health Advantage Medical Coverage (revision 12-19-2025)Pharmacy questions, "What about prescriptions for weight loss or smoking cessation?"SAS Employee Benefits Division (State of Arkansas)retrieved 2026-11-10↩“Weight loss medications are not a covered benefit.”
  81. 81.
    2026 ARBenefits Summary Plan Document (revision 12-19-2025)Pharmacy questions, "Who coordinates the prescription medication program?"SAS Employee Benefits Division (State of Arkansas)retrieved 2026-11-10↩“EBD has a contract with Navitus Health Solutions, LLC, who serves as the PBM (Pharmacy Benefit Manager) for the Plan.”
  82. 82.
    Medi-Cal Rx Contract Drugs List, November 1, 2026GLP-1 Drugs for Weight Loss: Non-Benefit (p. 5)DHCS / Medi-Cal Rxretrieved 2026-11-09↩“Effective January 1, 2026, GLP-1 drugs when used for weight loss or weight loss-related indications are not a Medi-Cal Rx covered benefit except for members younger than 21 years of age pursuant to the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.”
  83. 83.
    Medi-Cal Rx State Budget Policy Updates – FAQs (04/06/2026)Exclusion of GLP-1 Drugs for Weight Loss, Q11–Q15DHCS / Medi-Cal Rxretrieved 2026-11-09↩“Note: GLP-1 drugs for weight loss are excluded for members 21 years of age and older.”
  84. 84.
    Medi-Cal Rx Contract Drugs List, November 1, 2026Hormones: Hypoglycemics; Miscellaneous (Semaglutide (Wegovy))DHCS / Medi-Cal Rxretrieved 2026-11-09↩“Restricted to use in improving glycemic control in patients with type 2 diabetes mellitus”
  85. 85.
    Board of Administration Agenda Item 8c: SB 1089 (Richardson), June 17, 2026Current Federal, State, and CalPERS Coverage Requirements for GLP-1 Medications (p. 3)CalPERSretrieved 2026-11-09↩“CalPERS’ Knox-Keene regulated plans that manage their own pharmacy benefit, including HMO plans offered by Blue Shield of California and Kaiser Permanente, cover GLP-1 medications for morbid obesity (BMI ≥ 40 kg/m2), subject to prior authorization requirements.”
  86. 86.
    Preferred Drug List (PDL), Effective October 13, 2026Diabetes Management Classes, Non-Insulins: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 Analogues), effective 10/1/2026Colorado Department of Health Care Policy and Financingretrieved 2026-11-10↩“Note: Prior Authorization for GLP-1 analogues prescribed solely for weight loss will not be approved.”
  87. 87.
    Preferred Drug List (PDL), Effective October 13, 2026GLP-1 Analogues: Wegovy criteriaColorado Department of Health Care Policy and Financingretrieved 2026-11-10↩“Member has established cardiovascular disease (history of myocardial infarction, stroke, or symptomatic peripheral arterial disease) and either obesity or overweight (defined as a BMI ≥25 kg/m2) AND”
  88. 88.
    Preferred Drug List (PDL), Effective October 13, 2026GLP-1 Analogues: Preferred and Non-Preferred listsColorado Department of Health Care Policy and Financingretrieved 2026-11-10↩“*MOUNJARO (tirzepatide) pen *OZEMPIC (semaglutide) pen, tablet *TRULICITY (dulaglutide) pen *VICTOZA BNR (liraglutide) pen”
  89. 89.
    Medical Benefits: FAQs, GLP-1s for Weight Loss Coverage ChangeFAQs: GLP-1s for Weight Loss Coverage ChangeColorado Department of Personnel & Administration, Division of Human Resourcesretrieved 2026-11-10↩“Effective May 1, 2026, employee health plans will cover GLP-1s for weight loss.”
  90. 90.
    Frequently Asked Questions: GLP-1 Coverage Change (2025)Page 1Colorado Department of Personnel & Administration, Division of Human Resourcesretrieved 2026-11-10↩“Effective July 1 2025, coverage of GLP-1s for weight loss will be removed.”
  91. 91.
    Notice of Proposed Medicaid State Plan Amendment (SPA) 25-0014 Pharmacy Obesity Weight Loss Drug CoverageChanges to Medicaid State PlanConnecticut Department of Social Servicesretrieved 2026-11-10↩“SPA 25-0014 will amend Attachment 4.19-B in order to provide limited coverage of the Food and Drug Administration (FDA) approved weight loss medications to include orlistat, Xenical, and phentermine.”
  92. 92.
    Notice of Decision, Request #282222 (Zepbound under the HUSKY Health Plan, 2026)Conclusions of Law, item 7 (SPA 25-0014)Connecticut Department of Social Services, Office of Legal Counsel, Regulations, and Administrative Hearingsretrieved 2026-11-10↩“With respect to FDA approved weight loss medications, the only medications for which coverage is afforded are orlistat and phentermine.”
  93. 93.
    Testimony before the Human Services Committee, Commissioner Andrea Barton Reeves (March 6, 2025)Senate Bill 1421: An Act Concerning Medicaid Coverage for Obesity TreatmentConnecticut Department of Social Services (Connecticut General Assembly testimony file)retrieved 2026-11-10↩“Currently there are two generic GLP-1s approved by the federal Food and Drug Administration (FDA) to treat type 2 diabetes and we cover both.”
  94. 94.
    DSS MAPOC Presentation, July 10, 2026Pharmacy prior authorization pilot: grandfatheringConnecticut Department of Social Services (Medical Assistance Program Oversight Council)retrieved 2026-11-10↩“As of April 1, 2026, grandfathering ended for non-preferred prescriptions for Antipsoriatic topicals, Antimigraine: Other, and Hypoglycemics, Incretin Mimetics/Enhancers (GLP-1s for diabetes)”
  95. 95.
    Weight ManagementMedical Weight Management and FAQ: EligibilityCare Compass, Connecticut Office of the State Comptrollerretrieved 2026-11-10↩“Medications prescribed for weight loss or weight management are covered by the plan ONLY if they are prescribed through FlyteHealth or Connecticut Children’s Weight Management providers”
  96. 96.
    Comptroller Sean Scanlon Announces Continued Partnership With Intellihealth (June 13, 2024)Press release bodyConnecticut Office of the State Comptrollerretrieved 2026-11-10↩“As of July 1, 2023, any Plan member seeking a GLP-1 prescription for weight loss is required to enroll in Flyte.”
  97. 97.
    Pharmacy Preferred Drug List (PDL), effective September 18, 2026Page 1, "Excluded classes and drugs include" listDistrict of Columbia Department of Health Care Finance (via its pharmacy portal, dc.fhsc.com)retrieved 2026-11-10↩“Anti-obesity drugs”
  98. 98.
    DC Healthy Families Formulary (List of Covered Drugs), effective 10/01/2026Page 23, Anti-Obesity Agents (Wegovy and Zepbound pens, PA and quantity limits)MedStar Family Choice DCretrieved 2026-11-10↩“PA, QL (4 pens every 28 days); Covered for age 18 and older”
  99. 99.
    Pharmacy Preferred Drug List (PDL), effective September 18, 2026Page 21, Hypoglycemics: Incretin Mimetics and Enhancers, GLP-1 Receptor Agonists (Preferred: liraglutide, Trulicity, Ozempic Injection; Requires Prior Authorization: exenatide pen, Mounjaro, Ozempic tabs, Rybelsus, Soliqua, Victoza, Xultophy)District of Columbia Department of Health Care Finance (via its pharmacy portal, dc.fhsc.com)retrieved 2026-11-10↩“Non-preferred medications require prior authorization”
  100. 100.
    Pharmacy Preferred Drug List (PDL), effective September 18, 2026Page 1, scope of the PDLDistrict of Columbia Department of Health Care Finance (via its pharmacy portal, dc.fhsc.com)retrieved 2026-11-10↩“Any Therapeutic Drugs Classes not listed are not part of the PDL but will continue to be covered for Washington DC Medicaid Fee for service members.”
  101. 101.
    2026 DC Government Benefits GuideMedical Benefits, District of Columbia Employee Health Benefits Program (DCEHB), Health Care Providers & PlansDC Department of Human Resourcesretrieved 2026-11-10↩“For all employees hired on or after October 1, 1987.”
  102. 102.
    Florida Medicaid Prescribed Drug Services Coverage Policy (December 2017)5.2 Specific Non-Covered CriteriaAgency for Health Care Administrationretrieved 2026-11-09↩“Florida Medicaid does not cover the following as part of this service benefit: ... Weight control medications”
  103. 103.
    Florida Medicaid Preferred Drug List, Effective October 1, 2026C4I ANTIHYPERGLY,INCRETIN MIMETIC(GLP-1 RECEP.AGONIST); C4Z; no Wegovy, Zepbound, Saxenda or Foundayo rowsAgency for Health Care Administrationretrieved 2026-11-09↩“OZEMPIC 4 MG TABLET SEMAGLUTIDE 18 999 Clinical PA”
  104. 104.
    Glucagon-like Peptide-1 (GLP-1) Receptor Agonists prior authorization criteria (revised October 1, 2026)Preferred agents; Review criteriaAgency for Health Care Administrationretrieved 2026-11-09↩“Preferred agents (Clinical Prior Authorization Required): Mounjaro® (tirzepatide), Ozempic® (semaglutide) injection and tablets, Rybelsus® (semaglutide), and Trulicity® (dulaglutide)”
  105. 105.
    Weight Management ProgramProgram Highlights; Eligibility CriteriaFlorida Department of Management Services, MyBenefitsretrieved 2026-11-09↩“For 2027, the WMP will be open to 2,000 participants”
  106. 106.
    Prescription Drug PlanGlossary: Pharmacy Benefit ManagerFlorida Department of Management Services, MyBenefitsretrieved 2026-11-09↩“Your PBM is Optum Rx.”
  107. 107.
    Georgia Medicaid/PeachCare Preferred Drug List, Effective November 1, 2026 (by therapeutic class)Antilipidemic Drugs (SAXENDA row) and Misc. Antidiabetic AgentsGeorgia Department of Community Healthretrieved 2026-11-10↩“MOUNJARO P PA QLL OZEMPIC INJ. P PA QLL RYBELSUS NP PA QLL”
  108. 108.
    Georgia Medicaid/PeachCare Preferred Drug List, Effective October 1, 2026Header key; Antilipidemic Drugs, SAXENDA rowGeorgia Department of Community Healthretrieved 2026-11-10↩“SAXENDA NP PA (12 yrs-17 yrs)”
  109. 109.
    Georgia Medicaid Fee-for-Service Antidiabetic Agents PA SummaryMiscellaneous Antidiabetic Agents table and PA Criteria (revised 07/01/2026)Georgia Department of Community Healthretrieved 2026-11-10↩“*Preferred but requires PA”
  110. 110.
    2027 Active Member Pharmacy CoveragePage 3: 2027 Weight Loss ManagementGeorgia State Health Benefit Planretrieved 2026-11-10↩“Coverage for weight-loss medications will continue in 2027, subject to the applicable plan’s coverage requirements”
  111. 111.
    9amHealth Weight Management ProgramChanges to Weight Management Program Effective October 1, 2026Georgia State Health Benefit Planretrieved 2026-11-10↩“Effective October 1, 2026, participation in the 9amHealth program will be optional and no longer be required in order to obtain your weight loss medication.”
  112. 112.
    H.B. No. 2456, H.D. 1: Relating to Drugs for Weight Loss (2026)Section 1, findingsHawaii State Legislature, House of Representativesretrieved 2026-11-10↩“the department of human services has opted to exclude these medications from coverage under medicaid in most situations.”
  113. 113.
    Testimony of the Department of Human Services on HB 2456, Relating to Drugs for Weight Loss (Feb. 4, 2026)DHS testimony, page 2 (hearing Feb. 5, 2026)Hawaii Department of Human Servicesretrieved 2026-11-10↩“One of Hawaii’s QUEST Integration Health Plans voluntarily covered weight loss medications for obesity temporarily, but rescinded coverage as costs increased exponentially.”
  114. 114.
    EUTF Board of Trustees Meeting Minutes, October 31, 2025 (approved)CVS Prescription Drug Plan Changes, motion on GLP-1 initial fillHawaii Employer-Union Health Benefits Trust Fundretrieved 2026-11-10↩“to add a 30-day initial fill limit on anti-diabetic and anti-obesity medication GLP-1s under the EUTF active and non-Medicare retiree prescription drug plans administered by CVS effective January 1, 2026.”
  115. 115.
    2026 Active Employee Reference GuidePlan changes, CVS prescription drug plan, item 9Hawaii Employer-Union Health Benefits Trust Fundretrieved 2026-11-10↩“Antidiabetic GLP-1s include Ozempic, Mounjaro, Rybelsus, Trulicity, and Victoza. Weight loss GLP-1s include Wegovy and Zepbound.”
  116. 116.
    IDAPA 16.03.26, Medicaid Plan Benefits, Docket No. 16-0326-2501 (2026 Temporary Rules Review Book, House Health and Welfare Committee)Section 212 (Prescription Drugs: Coverage and Limitations), Subsection 05, Excluded Drug Products, item b (p. 56)Idaho Department of Health and Welfare; Office of the Administrative Rules Coordinator, Division of Financial Managementretrieved 2026-11-10↩“Agents, when used for the treatment of obesity.”
  117. 117.
    IDAPA 16.03.26, Medicaid Plan Benefits, Docket No. 16-0326-2501: Notice of Rulemaking, Adoption of Temporary RuleNotice, Effective Date (p. 3)Idaho Department of Health and Welfare; Office of the Administrative Rules Coordinator, Division of Financial Managementretrieved 2026-11-10↩“The effective date of the temporary rule is July 1st, 2025.”
  118. 118.
    Idaho Medicaid Preferred Drug List with Prior Authorization Criteria (effective July 1, 2026, last revised September 1, 2026)Page 25, Hypoglycemics, Incretin Mimetics: GLP-1 Receptor Agonists, Additional CriteriaIdaho Department of Health and Welfare, Division of Medicaidretrieved 2026-11-10↩“ICD-10 diagnosis of type 2 diabetes mellitus in member’s record or submitted with pharmacy claim”
  119. 119.
    Idaho Medicaid Preferred Drug List with Prior Authorization Criteria (effective July 1, 2026, last revised September 1, 2026)Page 25, GLP-1 Receptor Agonists, Non-Preferred Agents column (no Wegovy, Zepbound, Saxenda or Foundayo listed anywhere in the document)Idaho Department of Health and Welfare, Division of Medicaidretrieved 2026-11-10↩“OZEMPIC tablet (semaglutide)”
  120. 120.
    Policy Update: Elimination of Coverage for Weight Loss Medications, Including GLP-1s for Weight Loss (memorandum dated Sept. 4, 2025)Elimination of Weight Loss Medication CoverageState of Idaho, Office of Group Insuranceretrieved 2026-11-10↩“Effective November 1, 2025, coverage for all medications prescribed for weight loss will be discontinued.”
  121. 121.
    Policy Update: Elimination of Coverage for Weight Loss Medications, Including GLP-1s for Weight Loss (memorandum dated Sept. 4, 2025)Elimination of Weight Loss Medication CoverageState of Idaho, Office of Group Insuranceretrieved 2026-11-10↩“This change does not impact coverage for GLP-1 medications when prescribed for the treatment of diabetes.”
  122. 122.
    Illinois Medicaid Preferred Drug List, Effective October 01, 2026p. 36, Anti-Obesity: GIP & GLP-1 Receptor Agonists; p. 23-24, Antidiabetics: Incretin Mimetic Agents (read via Internet Archive; linked from the HFS PDL page snapshot of 2026-10-16)Illinois Department of Healthcare and Family Servicesretrieved 2026-11-10↩“*Wegovy covered for MACE & MASH only. ... *Zepbound covered for OSA only. ... *Wegovy and Zepbound will not be covered for weight loss alone.”
  123. 123.
    GLP-1s Beyond Glycemic Control: Understanding Additional IndicationsCoverage Considerations (bulletin dated August 28, 2026)CountyCare (Cook County Health, Illinois Medicaid health plan)retrieved 2026-11-10↩“CountyCare's formulary aligns with the Illinois Department of Healthcare and Family Services (HFS), under which obesity and weight loss are benefit exclusions.”
  124. 124.
    Central Management Services (CMS) - State Employee Health Plan Formulary administered by CVS Caremark, 2026 List of Covered Drugsp. 25, Anti-Obesity Agents (effective 11/01/2026)CVS Caremark for the Illinois Department of Central Management Servicesretrieved 2026-11-10↩“ZEPBOUND SOAJ 2.5mg/0.5ml, 5mg/0.5ml, 7.5mg/0.5ml, 10mg/0.5ml, 12.5mg/0.5ml, 15mg/0.5ml ( tirzepatide (weight management)) 2 PA”
  125. 125.
    Prescription Coverage (State Employee Benefits)Prescription Coverage (read via Internet Archive snapshot of 2026-09-14)Illinois Department of Central Management Servicesretrieved 2026-11-10↩“Plan participants enrolled in HealthLink OAP, Aetna OAP, Blue Cross Blue Shield OAP, the Consumer Driven Health Plan (CDHP), or the Quality Care Health Plan (QCHP), have CVS/caremark as their PBM.”
  126. 126.
    Iowa Medicaid Preferred Drug List (PDL Effective Date October 1, 2026)Comment key, comment 12Iowa Department of Health and Human Services, Iowa Medicaidretrieved 2026-11-10↩“PA Required. Weight loss indication not covered”
  127. 127.
    Iowa Medicaid Preferred Drug List (PDL Effective Date October 1, 2026)Endocrine Metabolic Agents (Wegovy and Zepbound rows, comment 12, P) and Diabetic GLP-1 Receptor Agonists (Mounjaro, Trulicity, Victoza, Ozempic, Rybelsus rows, comment 11, P)Iowa Department of Health and Human Services, Iowa Medicaidretrieved 2026-11-10↩“B 12 P Wegovy”
  128. 128.
    Request for Prior Authorization: Anti-Diabetic Non-Insulin Agents (form 470-5259, Rev. 10/26)Page 1, criteria and drug tableIowa Medicaidretrieved 2026-11-10↩“Requests for weight loss, which is not a covered diagnosis of use, will be denied.”
  129. 129.
    Health Insurance (State of Iowa employees)Health insurance overviewIowa Department of Administrative Servicesretrieved 2026-11-10↩“All of the State-sponsored health insurance plans are provided by Wellmark Blue Cross and Blue Shield.”
  130. 130.
    Benefit Booklet: State of Iowa, Iowa Choice (Wellmark Blue HMO / BlueRx Value Plus Prescription Drug Plan), group effective date 1/1/2026Prescription Drugs, Drugs, Services, and Items that are Not Covered (pp. 41-42)Wellmark Health Plan of Iowa, posted by the Iowa Department of Administrative Servicesretrieved 2026-11-10↩“Weight reduction drugs.”
  131. 131.
    KRS 205.5366: Coverage for prescription drugs prescribed primarily for weight loss prohibitedStatute textKentucky General Assembly, Legislative Research Commissionretrieved 2026-11-10↩“shall not provide coverage for prescription drugs when prescribed primarily for weight loss.”
  132. 132.
    907 KAR 23:010. Outpatient Pharmacy ProgramSection 5. Exclusions to Coverage, (2)(a)Kentucky General Assembly, Legislative Research Commission (Kentucky Administrative Regulations)retrieved 2026-11-10↩“A drug if used for anorexia, weight loss, or weight gain”
  133. 133.
    Kentucky Medicaid Prior Authorization Criteria (version November 2026)Diabetes: Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, pp. 157-160Kentucky Department for Medicaid Services and MedImpactretrieved 2026-11-10↩“Drugs used for anorexia, weight loss, or weight gain are excluded from coverage.”
  134. 134.
    Kentucky Medicaid – Preferred Drug List (PDL), November 2026Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists row (Preferred with PA: Mounjaro pen, Ozempic pen, Trulicity pen, Victoza pen; Non-preferred: exenatide pen, liraglutide pen, Ozempic tablet, Rybelsus tablet, Soliqua pen, Xultophy pen)Kentucky Department for Medicaid Services and MedImpactretrieved 2026-11-10↩“PDL DRUG CATEGORY PREFERRED PREFERRED WITH PA NON-PREFERRED”
  135. 135.
    Kentucky Employees' Health Plan 2026 Benefits Selection GuideOpen Enrollment Highlights (p. 3), plan changes (p. 6) and benefit grid row 'GLP-1 Weight Loss Drugs'Kentucky Personnel Cabinet, Department of Employee Insuranceretrieved 2026-11-10↩“The LivingWell CDHP and the LivingWell PPO will have a change specific to GLP-1 weight loss drugs.”
  136. 136.
    Kentucky Employees' Health Plan 2026 Benefits Selection GuidePrescription Drug Coverage (p. 13)Kentucky Personnel Cabinet, Department of Employee Insuranceretrieved 2026-11-10↩“CVS/Caremark manages the prescription benefits for KEHP”
  137. 137.
    Medicaid Services Manual, Chapter 37: Pharmacy Benefits Management Services, Section 37.1 (issued 03/30/26)Section 37.1, Non-Covered Services, Drugs Excluded From Coverage, item 1Louisiana Department of Health (Louisiana Medicaid, via lamedicaid.com)retrieved 2026-11-10↩“Select agents when used for anorexia, weight loss, or weight gain with the exception of orlistat (Xenical);”
  138. 138.
    Preferred Drug List informationDrug categories not part of the Louisiana Medicaid Single PDLLouisiana Healthcare Connections (Healthy Louisiana managed care plan)retrieved 2026-11-10↩“Drugs prescribed for weight loss (with the exception of orlistat)”
  139. 139.
    Louisiana Medicaid Pharmacy Updated Criteria for GLP-1 Receptor Agonists - November 2024 (memorandum dated October 11, 2024, with criteria)Diabetes – Hypoglycemics – Incretin Mimetics / Enhancers, GLP-1 Agonists, Initial Approval CriteriaLouisiana Department of Health, Bureau of Health Services Financingretrieved 2026-11-10↩“The recipient has a diagnosis of type 2 diabetes mellitus”
  140. 140.
    Outpatient Pharmacy Drug Search (searches for Wegovy, Zepbound, Ozempic, Mounjaro, Rybelsus, Trulicity and Victoza returned records; Saxenda and Foundayo returned none)Search disclaimerLouisiana Medicaid (Gainwell Technologies for the Louisiana Department of Health)retrieved 2026-11-10↩“Only payable drugs are displayed. Information provided by the Outpatient Pharmacy Drug Search does not guarantee coverage or payment from the Program.”
  141. 141.
    Pharmacy BenefitsGLP-1 Medication CoverageLouisiana Office of Group Benefitsretrieved 2026-11-10↩“OGB's pharmacy benefit does not cover GLP-1 medications unless they are prescribed for the treatment of Type 2 diabetes.”
  142. 142.
    2026 OGB Magnolia Open Access Benefit Plan (40HR1695 R01/26)Exclusions, J. Prescription Drugs, item 2 (p. 102)Louisiana Office of Group Benefits (plan administered by Blue Cross and Blue Shield of Louisiana)retrieved 2026-11-10↩“medications for obesity, weight loss, weight management, or weight maintenance (e.g., Contrave®, Qsymia®, Saxenda®, Zepbound®);”
  143. 143.
    MaineCare Preferred Drug List (effective October 1, 2026, amended October 9, 2026)Weight Loss category, criteria columnMaine DHHS, Office of MaineCare Services (PDL administered by Optum)retrieved 2026-11-10↩“Weight loss drugs are not covered as permitted by Federal Medicaid regulations and Maine Medicaid (MaineCare) Policy.”
  144. 144.
    MaineCare Preferred Drug List (effective October 1, 2026, amended October 9, 2026)Cardiometabolic Health Agents category (preferred column: Wegovy Inj, Wegovy Tab), criteria columnMaine DHHS, Office of MaineCare Services (PDL administered by Optum)retrieved 2026-11-10↩“Wegovy: Patient has BMI > 27 kg/m2, and is not being used for weight loss only”
  145. 145.
    MaineCare Preferred Drug List (effective October 1, 2026, amended October 9, 2026)Incretin Mimetic category (preferred column: Rybelsus, Trulicity, Victoza; non-preferred column: Ozempic at step 6, Adlyxin, Bydureon BCise, Soliqua, Xultophy), criteria columnMaine DHHS, Office of MaineCare Services (PDL administered by Optum)retrieved 2026-11-10↩“Preferred drugs must be tried and failed due to lack of efficacy or intolerable side effects before non-preferred drugs will be approved (in step order)”
  146. 146.
    MaineCare Preferred Drug List (effective July 1, 2026)Document header; Incretin Mimetic category lists no MounjaroMaine DHHS, Office of MaineCare Services (PDL administered by Optum)retrieved 2026-11-10↩“PDL Effective July 1, 2026”
  147. 147.
    Virta HealthVirta Responsible Prescribing - New as of July 1, 2026Maine Bureau of Human Resources, Office of Employee Health, Wellness, & Workers' Compensationretrieved 2026-11-10↩“Effective July 1, 2026: State of Maine Health Plan Members with GLP-1 prescriptions for weight loss are required to enroll in Virta Health and receive their GLP-1 prescription from a Virta provider to maintain coverage.”
  148. 148.
    Virta HealthVirta Responsible Prescribing - New as of July 1, 2026Maine Bureau of Human Resources, Office of Employee Health, Wellness, & Workers' Compensationretrieved 2026-11-10↩“After 10/30/2026, prescriptions for GLP-1 medications for weight loss filled outside of Virta will not be covered under the State of Maine Health Plan”
  149. 149.
    COMAR 10.09.03.05 Limitations (Pharmacy Services, Medical Care Programs)A(14)Maryland Division of State Documents, Library of Maryland Regulationsretrieved 2026-11-10↩“Oral drugs or injections for central nervous system stimulants, anorexigenics, and any other agents when used for weight control”
  150. 150.
    Maryland Medicaid Drug Use Review Board Meeting Minutes, March 5, 2026Office of Pharmacy Services (OPS), page 1Maryland Department of Health, Office of Pharmacy Servicesretrieved 2026-11-10↩“weight management and/or weight control are not covered by the Maryland Medicaid FFS program”
  151. 151.
    Maryland Medicaid Preferred Drug List, Effective 7/1/2026, Updated 8/6/2026Hypoglycemics, Incretin Mimetics and Enhancers: Preferred column lists liraglutide (Victoza), Mounjaro, Ozempic and Trulicity; the other column lists RybelsusMaryland Department of Health, Office of Pharmacy Servicesretrieved 2026-11-10↩“Non-Preferred / Requires Prior Authorization”
  152. 152.
    State of Maryland Prescription Benefits available through MedImpact Healthcare Systems, Inc. (2026 Evidence of Coverage)Non-Covered Prescription Drug BenefitsMaryland Department of Budget and Management / MedImpactretrieved 2026-11-10↩“Anorectics (any drug used for the purpose of weight loss)”
  153. 153.
    Guide to Your Health Benefits, January - December 2026Introduction; Prescription coverageMaryland Department of Budget and Managementretrieved 2026-11-10↩“options for the plan year January 1, 2026 - December 31, 2026.”
  154. 154.
    July 2026 MassHealth Drug List Summary UpdateChange in Coverage StatusMassHealth Drug Utilization Review Programretrieved 2026-11-10↩“Effective July 3, 2026, the following anti-obesity agents are excluded per MassHealth regulation 130 CMR 406.413(B)(7) and will no longer be covered.”
  155. 155.
    July 2026 MassHealth Drug List Summary UpdateUpdated MassHealth Brand Name Preferred Over Generic Drug List, item dMassHealth Drug Utilization Review Programretrieved 2026-11-10↩“Effective July 3, 2026, the following GIP/GLP-1 receptor agonist agent will be removed from the MassHealth Supplemental Rebate/Preferred Drug List. • Zepbound (tirzepatide) – PA”
  156. 156.
    MassHealth Drug List, Table 26: Antidiabetic AgentsTable Footnotes (table last revised 10/2026)MassHealthretrieved 2026-11-10↩“PD 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.”
  157. 157.
    MassHealth Drug List, Table 26: Antidiabetic AgentsIII. Evaluation Criteria, SmartPA note for liraglutide, Mounjaro, Ozempic, Rybelsus and TrulicityMassHealthretrieved 2026-11-10↩“Claims for liraglutide (generic Victoza), Mounjaro, Ozempic, Rybelsus, and Trulicity within the quantity limit (described above) and polypharmacy requirements will usually process at the pharmacy without a PA request”
  158. 158.
    June Update on Vida Health Program and GLP-1 CoverageQuick Summary (news item dated 6/08/2026)Group Insurance Commission (Mass.gov)retrieved 2026-11-10↩“Weight loss GLP-1 medicines will not be covered starting July 1, 2026.”
  159. 159.
    Prescription Drug Program Manual (updated 07/09/2026)Covered Products: What Drugs and Pharmaceutical Supplies Are Not Covered?Montana DPHHS, Montana Healthcare Programsretrieved 2026-11-10↩“The Montana Healthcare Programs Prescription Drug Program does not reimburse for the following items or services”
  160. 160.
    Prescription Drug Program Manual (updated 07/09/2026)Covered Products: What Drugs and Pharmaceutical Supplies Are Not Covered?, Drugs prescribed listMontana DPHHS, Montana Healthcare Programsretrieved 2026-11-10↩“For weight reduction”
  161. 161.
    Montana Healthcare Programs Preferred Drug List (PDL), September 10, 2026Diabetes: GLP-1/GIP and Combos (Preferred: Ozempic Injections, Trulicity, Victoza; Non-Preferred: Bydureon BCISE, exenatide pen, liraglutide, Mounjaro, Ozempic tabs, Rybelsus)Montana DPHHS, Montana Healthcare Programsretrieved 2026-11-10↩“Trial of 2 preferred agents for 6 months each required”
  162. 162.
    DUR Program News, Spring 2026: Prior Authorization Requirements for GLP-1/GIP and Combo AgentsPage 6, coverage for members with type 2 diabetesMountain Pacific (Montana Medicaid DUR Program, under contract with Montana DPHHS)retrieved 2026-11-10↩“A trial of two preferred agents from the Montana Preferred Drug list for six months each is required for approval of a non-preferred agent.”
  163. 163.
    Wrap Plan Document for Medical, Prescription Drug, Dental, Vision, Health Centers, and Wellness Program Benefits, State of Montana (effective January 1, 2026)Prescription Drug Benefit, Exclusions, item 6Montana Department of Administration, Health Care and Benefits Divisionretrieved 2026-11-10↩“Drugs prescribed for weight management.”
  164. 164.
    Wrap Plan Document, State of Montana (effective January 1, 2026)Medical exclusions, item 25Montana Department of Administration, Health Care and Benefits Divisionretrieved 2026-11-10↩“Services, supplies, drugs and devices for weight reduction or weight control.”
  165. 165.
    State Plan Amendment NE 23-0007, Attachment 3.1-A, Item 12a (Prescribed Drugs), transmittal submitted July 5, 2023Item 12a, excluded drugs covered under 1927(d)(2)Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Careretrieved 2026-11-10↩“agents when used for anorexia, weight loss, weight gain (limited to weight gain only)”
  166. 166.
    Fiscal Note, LB 907 (2024)Explanation of Estimate (prepared January 4, 2024)Nebraska Legislature, Legislative Fiscal Officeretrieved 2026-11-10↩“Medicaid currently excludes coverage for weight loss or anti-obesity medication.”
  167. 167.
    Nebraska Medicaid Preferred Drug List with Prior Authorization Criteria, November 2026 (updated November 2, 2026)Page 39, Diabetes Mellitus, Incretin Mimetics/Enhancers: GLP-1 RA criteriaNebraska DHHS and Prime Therapeutics State Government Solutionsretrieved 2026-11-10↩“Preferred agents require a diagnosis of Type II diabetes AND a trial and failure or intolerance to metformin”
  168. 168.
    Nebraska Medicaid Preferred Drug List with Prior Authorization Criteria, October 2026Diabetes Mellitus, Incretin Mimetics/Enhancers: GLP-1 RA non-preferred agentsNebraska DHHS and Prime Therapeutics State Government Solutionsretrieved 2026-11-10↩“RYBELSUS (semaglutide) AL,QL”
  169. 169.
    A Guide to Your Health Benefits: State of Nebraska $1,400 Deductible plan (effective 07/01/2026)Services Not Covered Under The Prescription Drug ProgramNebraska Department of Administrative Services, State Personnel Wellness and Benefits / Blue Cross and Blue Shield of Nebraskaretrieved 2026-11-10↩“diet, weight loss or appetite suppressant drugs (Anorexics), dietary and herbal or nutritional supplements;”
  170. 170.
    A Guide to Your Health Benefits: State of Nebraska $1,400 Deductible plan (effective 07/01/2026)Prescription drug program definitions: Pharmacy Benefit ManagerNebraska Department of Administrative Services, State Personnel Wellness and Benefits / Blue Cross and Blue Shield of Nebraskaretrieved 2026-11-10↩“Prime Therapeutics, LLC, (Prime) has been retained by BCBSNE to administer the Rx Nebraska Prescription Drug Program.”
  171. 171.
    Medicaid Services Manual Chapter 1200 – Prescribed Drugs (effective Nov. 2, 2026)Section 1203, C. ExcludedNevada Medicaidretrieved 2026-11-10↩“Agents used for weight management.”
  172. 172.
    Medicaid Services Manual Chapter 1200 – Prescribed Drugs (effective Nov. 2, 2026)Appendix A, Section KK. Incretin Mimetics, approval criteria 1.eNevada Medicaidretrieved 2026-11-10↩“Medication is not being prescribed for weight loss in absence of T2DM indication;”
  173. 173.
    Nevada Medicaid and Nevada Check Up Preferred Drug List (PDL), effective November 1, 2026Page 45, Hormones and Hormone Modifiers, Incretin Mimetics and Combinations, Preferred ProductsNevada Medicaid and Prime Therapeuticsretrieved 2026-11-10↩“Mounjaro QL PA Ozempic inj QL PA Ozempic tab QL PA Rybelsus QL PA Trulicity QL PA Victoza QL PA”
  174. 174.
    Web Announcement 3976: Silver State Scripts Board Made Changes to the Preferred Drug List Effective August 1, 2026Incretin Mimetics and Combinations rowNevada Medicaidretrieved 2026-11-10↩“Mounjaro moved from non-preferred to preferred with prior authorization”
  175. 175.
    Consumer Driven Health Plan Master Plan Document, Plan Year 2027 (July 1, 2026 – June 30, 2027)Prescription Drug BenefitsNevada Public Employees' Benefits Programretrieved 2026-11-10↩“Anti-obesity branded products are excluded from this benefit. Only generic products are covered.”
  176. 176.
    Consumer Driven Health Plan Master Plan Document, Plan Year 2027 (July 1, 2026 – June 30, 2027)Obesity Care Disease Management Program (Enhanced Benefits), Weight Loss MedicationsNevada Public Employees' Benefits Programretrieved 2026-11-10↩“The Plan covers certain only short-term use obesity/weight loss generic medications as identified by the Plan’s pharmacy benefits manager.”
  177. 177.
    Change in Medicaid Coverage for GLP-1 Medications (provider notice, October 9, 2025)Opening paragraphNew Hampshire Department of Health and Human Services, Division of Medicaid Servicesretrieved 2026-11-10↩“Effective January 1, 2026, New Hampshire Medicaid will no longer cover GLP-1 medications when prescribed solely for weight loss.”
  178. 178.
    Change in Medicaid Coverage for GLP-1 Medications (provider notice, October 9, 2025)What Providers Need to KnowNew Hampshire Department of Health and Human Services, Division of Medicaid Servicesretrieved 2026-11-10↩“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.”
  179. 179.
    Fee-for-Service Medicaid Preferred Drug List (PDL), effective November 1, 2026Endocrinology – Glucagon-Like Peptide-1 (GLP-1) Agonists and Combinations (p. 29)New Hampshire Department of Health and Human Services and Prime Therapeuticsretrieved 2026-11-10↩“Trial and failure of 2 Preferred products required prior to Non-Preferred products.”
  180. 180.
    GLP-1 Receptor Agonist Criteria (approval date May 12, 2026)Criteria for ApprovalNew Hampshire Medicaid Fee-for-Service Program and Prime Therapeuticsretrieved 2026-11-10↩“Patient has had a trial of an oral antihyperglycemic.”
  181. 181.
    Request to amend the Express Scripts pharmacy benefit contract (third amendment), Governor and Executive Council item 136, September 17, 2025Explanation (DAS letter dated August 28, 2025); read on a public mirror of G&C files because sos.nh.gov returned 403New Hampshire Department of Administrative Services, Division of Risk and Benefits (copy of a Governor and Executive Council item, hosted outside the state site)retrieved 2026-11-10↩“The State HBP does not cover GLP-1 medications for weight loss.”
  182. 182.
    NJ FamilyCare Coverage of Weight Loss Drugs (memo to the Legislature)2.1 NJ FamilyCare (estimates developed August 2025)New Jersey Department of Human Servicesretrieved 2026-11-10↩“Wegovy is covered when clinically appropriate for cardiovascular disease, and Zepbound is covered for sleep apnea.”
  183. 183.
    Drug Utilization Review Board Meeting Summary, October 16, 2024Prior authorization denials report, antidiabetics categoryNJ DHS Division of Medical Assistance and Health Servicesretrieved 2026-11-10↩“weight loss products are not part of NJ Medicaid covered benefits”
  184. 184.
    Addendum to the Protocol for Glucagon-Like Peptide-1 Receptor Agonists for Type 2 DiabetesFormulary with Step Therapy; Non-Formulary Agents (approved October 2022 and January 2023)Aetna Better Health of New Jerseyretrieved 2026-11-10↩“Non-Formulary Agents: Adlyxin (lixisenatide) Mounjaro (tirzepatide) Rybelsus (semaglutide)”
  185. 185.
    SHBP PDC Resolution #2025-11: Modify Prescription Drug Co-payments and Out of Pocket Maximum AmountsResolved, items 1 and 2 (dated September 24, 2025)New Jersey State Health Benefits Program Plan Design Committeeretrieved 2026-11-10↩“As of November 1, 2025, the member co-payment for non-diabetic GLP-1 drugs for weight loss shall be $45 per 30-day prescription in the SHBP Plans.”
  186. 186.
    Union Negotiated and Non-Aligned Plans: Prescription Plan Design, Plan Year 2027, State Active Group (HA-1157-0926)Copayment noteNew Jersey Division of Pensions and Benefitsretrieved 2026-11-10↩“Effective January 1, 2026, GLP-1 weight loss drugs Wegovy, Saxenda, and Zepbound have a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply.”
  187. 187.
    Weight Reduction MedicationsWeight Reduction Medications table, 'Not Covered by New Mexico Medicaid' columnNew Mexico Health Care Authorityretrieved 2026-11-10↩“Not Covered by New Mexico Medicaid Imcivree (setmelanotide) Saxenda (liraglutide) Wegovy (semaglutide) Zepbound (tirzepatide)”
  188. 188.
    Weight Reduction MedicationsIntroduction and Prior Authorization CriteriaNew Mexico Health Care Authorityretrieved 2026-11-10↩“Some weight loss medications for treating obesity are covered under the New Mexico Medicaid Fee-for-Service program with prior authorization.”
  189. 189.
    Frequently Asked Questions (FAQs): Medicaid Preferred Drug List (PDL), 7/27/26Questions 2 and 7New Mexico Health Care Authorityretrieved 2026-11-10↩“Drugs that are not on the PDL may still be covered. They will be independently managed by fee-for-service and each individual MCO.”
  190. 190.
    New Mexico Health Care Authority Preferred Drug List (PDL), effective July 1, 2026Cover page notes (table of contents lists no GLP-1 or incretin class)New Mexico Health Care Authority (prepared by Prime Therapeutics)retrieved 2026-11-10↩“HCA PDL only includes select drug classes”
  191. 191.
    Employee Benefits Pamphlet (updated 08/19/2026)SoNM Health Care PlansState of New Mexico State Health Benefits (mybenefitsnm.com)retrieved 2026-11-10↩“Pharmaceutical: Express Scripts/ESI/Evernorth”
  192. 192.
    Pharmacy Benefit Overview: State of New Mexico Health Care Authority - State Health BenefitsCover slideExpress Scripts (posted by State Health Benefits)retrieved 2026-11-10↩“Coverage Dates: July 1, 2026- June 30, 2027”
  193. 193.
    NYRx Coverage Overview of Glucagon Like Peptide-1 Receptor AgonistsPage 1, opening paragraphs (dated September 21, 2026)NYRx, the Medicaid Pharmacy Program (NYS DOH / Prime Therapeutics)retrieved 2026-11-09↩“GLP-1s remain excluded from coverage when used for the treatment of weight loss.”
  194. 194.
    NYRx Drug Class Coverage Overview: GLP-1 Receptor Agonists - Type 2 DiabetesClinical Criteria (09/13/23, Rev. 07/16/26)NYRx, the Medicaid Pharmacy Program (NYS DOH / Prime Therapeutics)retrieved 2026-11-09↩“Weight loss is not and never has been a Medicaid-covered indication.”
  195. 195.
    NYRx, the Medicaid Drug Program Preferred Drug List (Revised October 22, 2026)VI. Endocrine and Metabolic Agents - Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists - Type 2 Diabetes (p. 34). Preferred column: exenatide, Ozempic pen, Trulicity, Victoza BLTG. Non-preferred column: liraglutide (gen Victoza), Mounjaro, Ozempic tablets, Rybelsus, Soliqua, Xultophy.NYRx, the Medicaid Pharmacy Program (NYS DOH / Prime Therapeutics)retrieved 2026-11-09↩“PA required for patients utilizing a GLP-1 and DPP-IV concurrently”
  196. 196.
    NYRx Drug Class Coverage Overview: GLP-1 Receptor Agonists - Type 2 DiabetesPrior Authorization Requirements (09/13/23, Rev. 07/16/26)NYRx, the Medicaid Pharmacy Program (NYS DOH / Prime Therapeutics)retrieved 2026-11-09↩“Preferred drugs will not require PA if the required coverage parameters are found in the member’s Medicaid claim history at the time of pharmacy claim submission.”
  197. 197.
    2026 Empire Plan Advanced Flexible Formulary Preferred Drug List (October 2026)Drugs by therapeutic class - ANTI-OBESITY AGENTS (key: PA = Prior Authorization)NYS Department of Civil Service / CVS Caremarkretrieved 2026-11-09↩“ANTI-OBESITY AGENTS liraglutide PA CONTRAVE PA FOUNDAYO PA WEGOVY PA ZEPBOUND PA”
  198. 198.
    2026 Empire Plan Advanced Flexible Formulary Preferred Drug List (January 2026)Drugs by therapeutic class - ANTI-OBESITY AGENTSNYS Department of Civil Service / CVS Caremarkretrieved 2026-11-09↩“ANTI-OBESITY AGENTS liraglutide PA CONTRAVE PA WEGOVY PA ZEPBOUND PA”
  199. 199.
    GLP-1 Agonist and GIP/GLP-1 Agonist Prior Authorization FormPage 1, Diagnosis for this requestND Medicaid (Acentra Health, prior authorization vendor)retrieved 2026-11-10↩“Weight loss/obesity (please note, GLP-1 agonists and GIP/GLP-1 agonists are not covered for weight loss/obesity)”
  200. 200.
    Pharmacy Coverage Policy Manual: Preferred Drug List, Version 2026.7Weight Loss, Obesity (p. 87)North Dakota Department of Health and Human Services, Medical Services Divisionretrieved 2026-11-10↩“The following drugs are covered without prior authorization by submitting a corresponding diagnosis code for the indication: phentermine, bupropion, naltrexone, topiramate”
  201. 201.
    Pharmacy Coverage Policy Manual: Preferred Drug List, Version 2026.7Cover page and Version Changes (Diabetes)North Dakota Department of Health and Human Services, Medical Services Divisionretrieved 2026-11-10↩“Version 2026.7 Effective: October 1, 2026”
  202. 202.
    Pharmacy Coverage Policy Manual: Preferred Drug List, Version 2026.7Preferred Dosage Forms, semaglutide table (preferred, no PA | non-preferred, PA required) (p. 293)North Dakota Department of Health and Human Services, Medical Services Divisionretrieved 2026-11-10↩“OZEMPIC (semaglutide) INJECTION WEGOVY (semaglutide) INJECTION OZEMPIC (semaglutide) TABLETS WEGOVY (semaglutide) TABLETS RYBELSUS (semaglutide) TABLETS”
  203. 203.
    Testimony of Rebecca Fricke, NDPERS Executive Director, on House Bill 1452 (Jan. 28, 2025)Page 1, consultant analysis overviewNorth Dakota Legislative Assembly (testimony record)retrieved 2026-11-10↩“The current NDPERS health insurance plan only provides GLP-1 coverage for individuals diagnosed with diabetes.”
  204. 204.
    HB 1452 - Overview (2025 Regular Session)Measure Status, Last Official ActionNorth Dakota Legislative Branchretrieved 2026-11-10↩“Second reading, failed to pass, yeas 11 nays 82”
  205. 205.
    Ohio Administrative Code Rule 5160-9-03: Pharmacy services: covered drugs and non-covered drugsParagraph (B), Non-covered drugs (rule effective Feb. 16, 2024)Ohio Legislative Service Commission (Ohio Administrative Code), rule of the Ohio Department of Medicaidretrieved 2026-11-10↩“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.”
  206. 206.
    Unified Preferred Drug List, Medicaid Fee-for-Service and Managed Care Plans, Effective October 1, 2026Metabolic Modifier Agents: Glucagon-Like Peptide-1 (GLP-1) Agonists for Non-Obesity Indications, Preferred AgentsOhio Department of Medicaidretrieved 2026-11-10↩“Wegovy (semaglutide) PA inj (all excluding 7.2 mg), tab”
  207. 207.
    Unified Preferred Drug List, Effective October 1, 2026: Endocrine Agents: Diabetes – Non-InsulinGlucagon-Like Peptide-1 (GLP-1) Receptor Agonists & Combinations table (Preferred Agents | Non-Preferred Agents, PA Required)Ohio Department of Medicaidretrieved 2026-11-10↩“Byetta (exenatide) ... Mounjaro (tirzepatide) ... Trulicity (dulaglutide) ... Victoza (liraglutide)”
  208. 208.
    Unified Preferred Drug List, Effective October 1, 2026: Additional Mounjaro (tirzepatide) CriteriaEndocrine Agents: Diabetes – Non-Insulin, Additional Mounjaro (tirzepatide) CriteriaOhio Department of Medicaidretrieved 2026-11-10↩“Must have had an inadequate clinical response of at least 120 days with Ozempic (semaglutide)”
  209. 209.
    State of Ohio benefits package update (bulletin, April 29, 2025)Rising prescription drug costsOhio Department of Administrative Servicesretrieved 2026-11-10↩“GLP-1 medications for weight loss (Wegovy, Zepbound, Saxenda, etc.) will unfortunately no longer be covered by the state’s benefits plan effective July 1, 2025.”
  210. 210.
    MyBenefits Guide, July 1, 2025 – June 30, 2026Prescription Drugs, Drug Coverage Limitations (p. 13)Ohio Department of Administrative Servicesretrieved 2026-11-10↩“Effective July 1, 2025, new prescriptions for GLP-1 medications for weight loss, including Wegovy, Zepbound, and Saxenda, etc., will no longer be covered.”
  211. 211.
    317:30-5-72.1. Drug benefit [Revised 09-01-21](1) Excluded drugs, item (D)Oklahoma Health Care Authorityretrieved 2026-11-10↩“Drugs used primarily for the treatment of obesity, such as appetite suppressants are not covered.”
  212. 212.
    Prior Authorization 2026: Metabolic DisordersWegovy (Semaglutide Injection and Tablets) Approval Criteria [Cardiovascular (CV) Risk Reduction Indication Only]Oklahoma Health Care Authorityretrieved 2026-11-10↩“Wegovy® will not be approved for obese or overweight members in the absence of established CVD”
  213. 213.
    Prior Authorization 2026: Endocrine/Diabetics (Anti-Diabetic Medications tier chart)Anti-Diabetic Medications tier chart, GIP/GLP-1 Agonists row (Tier 1 empty; Tier 2: Trulicity, Victoza; Tier 3: Ozempic, Rybelsus; Special PA: Byetta, generic liraglutide, Mounjaro)Oklahoma Health Care Authorityretrieved 2026-11-10↩“LIRAGLUTIDE (VICTOZA®) – Brand Preferred”
  214. 214.
    Prior Authorization 2026: Endocrine/DiabeticsGlucagon-Like Peptide-1 (GLP-1) Agonists and GIP/GLP-1 Agonists Special PA Approval CriteriaOklahoma Health Care Authorityretrieved 2026-11-10↩“Documentation of member’s current A1c and goal A1c must be submitted with all requests”
  215. 215.
    HealthChoice Standard Medication List (April 2026)Plan member introductionHealthChoice (OMES Employees Group Insurance Division) and CVS Caremarkretrieved 2026-11-10↩“HealthChoice provides you with a prescription benefits administered by CVS Caremark®.”
  216. 216.
    HealthChoice Health Plans Handbook, Plan Year 2025 (High, High Alternative, Basic, Basic Alternative and High Deductible Health Plan)Plan Exclusions and Limitations, Drugs, item 7HealthChoice (OMES Employees Group Insurance Division)retrieved 2026-11-10↩“Certain weight loss drugs.”
  217. 217.
    Weight Management Drugs (prior authorization criteria)Table 3. Evidence-Supported IndicationsOregon Health Authority, Drug Use Research & Management (orpdl.org)retrieved 2026-11-10↩“Note: Drugs prescribed for only weight management (overweight or obesity) are NOT currently covered”
  218. 218.
    Weight Management Drugs (prior authorization criteria)Requires PA, noteOregon Health Authority, Drug Use Research & Management (orpdl.org)retrieved 2026-11-10↩“Tirzepatide is not currently covered for adults who do not have established obstructive sleep apnea or type 2 diabetes.”
  219. 219.
    Oregon Health Plan Drug Class List: Diabetes, GLP-1 Receptor Agonists and GIP TherapiesDrug table (PDL status: Y = preferred, N = non-preferred)Oregon Health Authority, Drug Use Research & Management (orpdl.org)retrieved 2026-11-10↩“semaglutide OZEMPIC PEN INJCTR N Pharmacy PA”
  220. 220.
    Glucagon-like Peptide-1 (GLP-1) Receptor Agonists and Glucose Dependent Insulinotropic Polypeptide (GIP) Receptor Agonist (prior authorization criteria)Requires PAOregon Health Authority, Drug Use Research & Management (orpdl.org)retrieved 2026-11-10↩“Preferred products do not require PA when prescribed as second-line therapy in conjunction with metformin.”
  221. 221.
    PEBB 2026 Statewide Plan Member Handbook5.11.9 Prescription Drug Exclusions, item 14 (handbook effective January 01, 2026)Providence Health Plan, for the Oregon Public Employees' Benefit Boardretrieved 2026-11-10↩“Drugs used for weight loss;”
  222. 222.
    PEBB 2026 Choice Plan Member Handbook5.11.9 Prescription Drug Exclusions, item 14 (handbook effective January 01, 2026)Providence Health Plan, for the Oregon Public Employees' Benefit Boardretrieved 2026-11-10↩“Drugs used for weight loss;”
  223. 223.
    MA Bulletin 01-26-39: Coverage Change and Prior Authorization of Obesity Treatment Agents – Pharmacy ServicesBackground/Discussion (issued Nov. 24, 2025, effective Jan. 1, 2026)Pennsylvania Department of Human Services, Office of Medical Assistance Programsretrieved 2026-11-10↩“Effective January 1, 2026, drugs containing a GLP-1 receptor agonist will not be covered for the treatment of overweight or obesity.”
  224. 224.
    MA Bulletin 01-26-37: Coverage Change and Prior Authorization of GLP-1 Receptor Agonists – Pharmacy ServicesHandbook pages, Requirements for Prior Authorization of GLP-1 Receptor Agonists, notePennsylvania Department of Human Services, Office of Medical Assistance Programsretrieved 2026-11-10↩“Saxenda (liraglutide) will no longer be covered for any indication.”
  225. 225.
    Pennsylvania Statewide Preferred Drug List, Effective January 2026 v16GLP-1 Receptor AgonistsPennsylvania Department of Human Servicesretrieved 2026-11-10↩“Ozempic (semaglutide) PenPA, QL ... Trulicity (dulaglutide) PenPA, QL ... Victoza (liraglutide) PenPA, QL”
  226. 226.
    Pennsylvania Statewide Preferred Drug List, Effective January 4, 2027 v2GLP-1 Receptor AgonistsPennsylvania Department of Human Servicesretrieved 2026-11-10↩“Wegovy (semaglutide) TabletPA, QL ... Zepbound (tirzepatide) KwikpenPA, QL”
  227. 227.
    Memorandum to RI Medicaid Providers: GLP-1 State Budget Guidance (August 5, 2026)First paragraphRhode Island Executive Office of Health and Human Servicesretrieved 2026-11-10↩“beginning October 1, 2026, Rhode Island Medicaid will no longer cover certain GLP-1 receptor agonists when they are prescribed solely for weight loss.”
  228. 228.
    Memorandum to RI Medicaid Providers: GLP-1 State Budget Guidance (August 5, 2026)List of affected medicationsRhode Island Executive Office of Health and Human Servicesretrieved 2026-11-10↩“Foundayo (Orforglipron) Saxenda (Liraglutide) Wegovy (Semaglutide) Zepbound (Tirzepatide)”
  229. 229.
    Rhode Island Medicaid Fee for Service Preferred Drug List (updated 10/01/2026)GLP-1 Receptor Agonists (Preferred: Byetta, Ozempic, Trulicity, Victoza; Non-Preferred: exenatide, liraglutide, Bydureon BCISE, Mounjaro, Ozempic tablet, Rybelsus, Soliqua, Xultophy)Rhode Island Executive Office of Health and Human Servicesretrieved 2026-11-10↩“Clinical Criteria for GLP-1 Receptor Agonists - History of either metformin or TZD therapy in the past 90 days”
  230. 230.
    Rhode Island Medicaid Fee for Service Preferred Drug List (updated 10/01/2026)Introduction, general ruleRhode Island Executive Office of Health and Human Servicesretrieved 2026-11-10↩“The general rule to receive a non-preferred agent is to try a preferred agent in the same therapeutic class in the past 90 days.”
  231. 231.
    State of Rhode Island 2026 Open Enrollment MailerBenefits overview, Prescription DrugState of Rhode Island Office of Employee Benefitsretrieved 2026-11-10↩“All medical plan options come with prescription drug coverage (retail and mail order) administered by CVS Caremark.”
  232. 232.
    Pharmacy and Therapeutics (P&T) Committee Meeting Minutes, November 5, 2025IV. State UpdatesSouth Carolina Department of Health and Human Servicesretrieved 2026-11-10↩“Dr. Wessinger notified committee members that GLP-1 medications for obesity would be removed from the PDL 12/31/2025. There will be no changes to GLP-1 products with respect to the indication for diabetes. Wegovy will continue to be covered for indications other than obesity (e.g., MACE/MASH).”
  233. 233.
    Select News, Winter 2026IMPORTANT Pharmacy Changes in 2026First Choice by Select Health of South Carolina (Medicaid managed care plan)retrieved 2026-11-10↩“Effective January 1, 2026, coverage for Wegovy for the treatment of obesity will be removed from South Carolina Department of Health and Human Services’ (SCDHHS) preferred drug list. Beginning December 1, 2025, no new prior authorizations for these drugs for weight loss will be accepted.”
  234. 234.
    Single Preferred Drug List (PDL), effective November 1, 2026Endocrine and Metabolic – Anti-Diabetics, GLP-1/GIP Agonists – Injectable (page 29)South Carolina Department of Health and Human Services (prepared by Prime Therapeutics)retrieved 2026-11-10↩“PREFERRED NON-PREFERRED Ozempic injection exenatide injection (generic for Byetta) Trulicity injection liraglutide injection (generic for Victoza) Mounjaro injection Soliqua injection Victoza injection Xultophy injection”
  235. 235.
    GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists Criteria (revised 10/01/2026)Adults criteria to approve; Other products; Revision historySouth Carolina Medicaid pharmacy program (Prime Therapeutics)retrieved 2026-11-10↩“Trial or failure of preferred products (Ozempic and Trulicity or rationale as to why the preferred products cannot be used).”
  236. 236.
    2026 Insurance Benefits GuideState Health Plan Prescription Drug Program, Exclusions (pp. 73–74)South Carolina Public Employee Benefit Authority (PEBA)retrieved 2026-11-10↩“Examples of other drugs that are not covered are: • Drugs in FDA Phase I, II or III testing; • Prescription drugs used for weight loss”
  237. 237.
    Health Care Policy Committee meeting materials, October 23, 2024GLP-1s (cost drivers) and GLP-1 managementSouth Carolina Public Employee Benefit Authority (PEBA)retrieved 2026-11-10↩“Weight loss coverage is a Plan exclusion, and neither of these products is FDA-approved for weight loss.”
  238. 238.
    Preferred Drug List (PDL 2026)PDL 2026 tab, Antidiabetics GLP-1 Receptor Agonists row (content served from contenthub-aem.optumrx.com getsdpdlcontent)OptumRx for the South Dakota Department of Social Services, Division of Medicaid Servicesretrieved 2026-11-10↩“ANTIDIABETICS GLP-1 RECEPTOR AGONISTS **No coverage for weight loss”
  239. 239.
    Wegovy Prior Authorization Request Form (Wegovy_SouthDakotaMedicaid_2026April)Page 1, Clinical Information, diagnosisOptumRx for South Dakota Medicaidretrieved 2026-11-10↩“Not covered for obesity or weight management or Type 2 diabetes mellitus”
  240. 240.
    Preferred Drug List (PDL 2026), page notesPDL page headingOptumRx for the South Dakota Department of Social Services, Division of Medicaid Servicesretrieved 2026-11-10↩“If a medication is not listed within a PDL class, it is considered Non-Preferred for that class and may require additional steps for approval.”
  241. 241.
    2026–2027 Employee Benefits Guide and Reference ManualPharmacy Benefits, page 12State of South Dakota, Bureau of Human Resources and Administrationretrieved 2026-11-10↩“Along with our health plans, Wellmark is administering the State’s pharmacy benefits.”
  242. 242.
    Formulary Drug Search: WegovySearch Results: WEGOVY 1.5 MG TABLET row (Medicaid PA Required; Programs/Coverage Dates)Texas HHSC Vendor Drug Programretrieved 2026-11-09↩“FFS Clinical: Yes ... Medicaid start: 08/11/2026”
  243. 243.
    Formulary Drug Search: ZepboundSearch Results: ZEPBOUND 2.5 MG/0.5 ML PEN rowTexas HHSC Vendor Drug Programretrieved 2026-11-09↩“FFS Clinical: Yes ... Medicaid start: 11/04/2025”
  244. 244.
    Criteria Guide for the Texas Prior Authorization Program: PDL Criteria, July 24, 202663 Hypoglycemics, Incretin Mimetics/Enhancers, Alternate TherapiesAcentra Health for Texas HHSC Vendor Drug Programretrieved 2026-11-09↩“Preferred Incretin Mimetics/Enhancer Therapies ... OZEMPIC 0.25-0.5 MG/DOSE PEN ... TRULICITY 0.75 MG/0.5 ML PEN ... VICTOZA 2-PAK 18 MG/3 ML PEN”
  245. 245.
    Summary of Oct. 23, 2026, DUR Board Preferred Drug List Updates AvailableHypoglycemics, Incretin Mimetic Agents table (published Nov. 5, 2026)Texas HHSC Vendor Drug Programretrieved 2026-11-09↩“Mounjaro (subcut) pen injctr | Non-Preferred | Preferred”
  246. 246.
    Master Benefit Plan Document: HealthSelect of Texas Prescription Drug Program, Effective September 1, 2026Section 7 - Exclusions, Drugs Prescribed for the Treatment of Obesity (p. 40)Employees Retirement System of Texas / Express Scriptsretrieved 2026-11-09↩“Drugs prescribed and dispensed solely for the treatment of obesity, with an FDA Indication only for weight loss”
  247. 247.
    Master Benefit Plan Document: HealthSelect of Texas Prescription Drug Program, Effective September 1, 2025Exclusions, Drugs Prescribed for the Treatment of ObesityEmployees Retirement System of Texas / Express Scriptsretrieved 2026-11-09↩“may be covered for adults with established cardiovascular disease (CVD) and who are either obese or overweight”
  248. 248.
    Medicaid Information Bulletin, May 202626-45 GLP-1 Agonists for Weight Loss (p. 8)Utah Department of Health and Human Services, Utah Medicaidretrieved 2026-11-10↩“Effective June 30, 2026, Utah Medicaid fee-for-service (FFS) will no longer cover GLP-1 agonists, including Wegovy, Saxenda, and Zepbound for weight loss for FFS members.”
  249. 249.
    Medicaid Information Bulletin, May 202626-45 GLP-1 Agonists for Weight Loss (p. 8)Utah Department of Health and Human Services, Utah Medicaidretrieved 2026-11-10↩“Utah Medicaid will continue to cover GLP-1 agonists for other FDA-approved indications, including major adverse cardiovascular events, metabolic dysfunction-associated steatohepatitis, and severe obstructive sleep apnea.”
  250. 250.
    Utah Medicaid Fee-for-Service Preferred Drug List (effective November 1, 2026)Page 13, GLP-1 Agonists class notesUtah Department of Health and Human Services, Utah Medicaidretrieved 2026-11-10↩“GLP-1 Agonists are only covered for type 2 diabetes mellitus.”
  251. 251.
    Utah Medicaid Fee-for-Service Preferred Drug List (effective November 1, 2026)Page 13, GLP-1 Agonists, preferred drugsUtah Department of Health and Human Services, Utah Medicaidretrieved 2026-11-10↩“Mounjaro Preferred Brand 09/01/26 2ml per 28 days, min age of 10 years old”
  252. 252.
    Weight ManagementGLP-1 MedicationsPublic Employees' Benefit and Insurance Program (PEHP)retrieved 2026-11-10↩“While PEHP covers GLP-1 medications for diabetes treatment, coverage doesn’t extend to weight loss under health benefits.”
  253. 253.
    Covered Drugs & PreauthorizationCovered Drugs & PreauthorizationPublic Employees' Benefit and Insurance Program (PEHP)retrieved 2026-11-10↩“You can access your Express Scripts Account via your PEHP account.”
  254. 254.
    Vermont Preferred Drug List and Drugs Requiring Prior Authorization (effective Oct. 2, 2026)Introduction, page 1Department of Vermont Health Accessretrieved 2026-11-10↩“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.”
  255. 255.
    Vermont Preferred Drug List and Drugs Requiring Prior Authorization (effective Oct. 2, 2026)Cardiometabolic Health Agents, PA Criteria: WegovyDepartment of Vermont Health Accessretrieved 2026-11-10↩“Medication is not being used for weight loss only”
  256. 256.
    Vermont Preferred Drug List and Drugs Requiring Prior Authorization (effective Oct. 2, 2026)Diabetic Agents, Peptide Hormones: GLP-1 Receptor Agonists (preferred: Exenatide, Mounjaro, Ozempic auto-injector pen, Rybelsus, Trulicity, Victoza), PA CriteriaDepartment of Vermont Health Accessretrieved 2026-11-10↩“Clinical criteria for all drugs: patient has a diagnosis of Type 2 Diabetes Mellitus.”
  257. 257.
    State of Vermont Prescription Drug Plan (effective Jan. 1, 2027)Prescription Drug Benefits, Covered DrugsState of Vermont Department of Human Resourcesretrieved 2026-11-10↩“The Prescription Drug Plan has adopted the PBM’s formulary, including the PBM’s preferred drug list, as its covered formulary.”
  258. 258.
    State of Vermont Prescription Drug Plan (effective Jan. 1, 2027)Specific Exclusions/LimitationsState of Vermont Department of Human Resourcesretrieved 2026-11-10↩“A list of excluded medications is available on the PBM’s website.”
  259. 259.
    Anorexiants/Anti-Obesity: GLP-1 Receptor Agonists – Wegovy (semaglutide), Medical policy no. 61.25.20.AA-4 (effective 2/1/2026)Clinical policy, Weight Loss rowWashington State Health Care Authorityretrieved 2026-11-10↩“Semaglutide injection or tablet (Wegovy®) is not covered by Apple Health for weight loss”
  260. 260.
    Anorexiants/Anti-Obesity: GLP-1 Receptor Agonists – Zepbound (tirzepatide), Medical policy no. 61.25.25.AA-1Clinical policy, Weight Loss rowWashington State Health Care Authorityretrieved 2026-11-10↩“Tirzepatide (Zepbound®) is not covered by Apple Health for weight loss”
  261. 261.
    Apple Health (Medicaid) Preferred Drug List (effective November 7, 2026 - November 13, 2026)PDL sheet header and GLP-1 rows (pharmacy preferred status P or N); Wegovy and Zepbound rows are preferred with PA under policies 612520AA and 612525AAWashington State Health Care Authorityretrieved 2026-11-10↩“Effective November 7, 2026 - November 13, 2026”
  262. 262.
    Antidiabetics – GLP-1 Agonists, Medical policy no. 27.17.00-5 (effective 7/1/2026)Clinical policy, Type 2 diabetes criteriaWashington State Health Care Authorityretrieved 2026-11-10↩“Diagnosis of type 2 diabetes or an HbA1c ≥ 6.5 within the last 12 months”
  263. 263.
    2026 UMP Classic (PEBB) Certificate of Coverage (HCA 54-0015)Exclusions, item 131 Weight control, weight loss, and obesity treatment (also the prescription drug exclusions list: Obesity (or weight loss))Washington State Health Care Authority, Public Employees Benefits Board Programretrieved 2026-11-10↩“Non-surgical: Any program, drugs, services, or supplies for weight control, weight loss, or obesity treatment.”
  264. 264.
    2026 UMP Classic (PEBB) Certificate of Coverage (HCA 54-0015)About UMP Classic (cover: Effective January 1, 2026)Washington State Health Care Authority, Public Employees Benefits Board Programretrieved 2026-11-10↩“UMP is administered by Regence BlueShield and ArrayRx. Moda Health administers the UMP pharmacy benefits for ArrayRx.”
  265. 265.
    Chapter 518 Pharmacy Services (effective 7/1/2026)518.3 Non-Covered ServicesWest Virginia Bureau for Medical Servicesretrieved 2026-11-10↩“Agents used for weight loss, anorexia, or weight gain, including binge-eating disorder;”
  266. 266.
    Preferred Drug List and Prior Authorization Criteria Q4 v7 (effective 10/1/2026)Obstructive Sleep Apnea Agents classWest Virginia Bureau for Medical Services, Office of Pharmacy Servicesretrieved 2026-11-10↩“OBSTRUCTIVE SLEEP APNEA AGENTS”
  267. 267.
    Preferred Drug List and Prior Authorization Criteria Q4 v7 (effective 10/1/2026)Diabetes Agents, GLP-1 Agonists class; MACE Reduction Agents, GLP-1 Agonists classWest Virginia Bureau for Medical Services, Office of Pharmacy Servicesretrieved 2026-11-10↩“Preferred agents may be authorized with a diagnosis of Diabetes Mellitus Type II.”
  268. 268.
    Summary Plan Description, PPB Gold and Silver Plans, July 1, 2026 – June 30, 2027Prescription Drug Benefits, Drugs or Services That Are Not Covered (p. 132)West Virginia Public Employees Insurance Agencyretrieved 2026-11-10↩“Anorexiants (any drug used for the purpose of weight loss)”
  269. 269.
    Summary Plan Description, PPB Gold and Silver Plans, July 1, 2026 – June 30, 2027Prescription Drug Benefits, medications that require prior authorization (p. 131)West Virginia Public Employees Insurance Agencyretrieved 2026-11-10↩“The GLP1 class of medications is covered for Type 2 diabetes only.”
  270. 270.
    Wyoming Medicaid Pharmacy Provider Manual (effective October 2026, Revision 28)Pharmacy Covered Services & Limitations Module, Legend Drug Exclusions (All Medicaid Plans)Wyoming Department of Health, Division of Healthcare Financingretrieved 2026-11-10↩“Anorexiant products”
  271. 271.
    WY P&T Committee Meeting Minutes, May 14, 2026New Drugs, item v (Foundayo)Wyoming Medicaid Pharmacy & Therapeutics Committee (University of Wyoming DUR program)retrieved 2026-11-10↩“This is an FYI only. Weight loss agents are not currently covered. No action is necessary.”
  272. 272.
    Wyoming Medicaid Preferred Drug List (PDL), June 8, 2026Incretin Mimetics (GLP-1 Receptor Agonists): preferred exenatide, Ozempic (tablets), Rybelsus, Trulicity, Victoza*; non-preferred liraglutide, Mounjaro, Ozempic*, Soliqua, XultophyWyoming Medicaid (Optum Rx)retrieved 2026-11-10↩“Trial and failure of metformin greater than or equal to a 90 day supply in the last 12 months will be required before approval can be given for a preferred agent unless ASCVD or risk factors are present, in which case the trial of metformin is waived.”
  273. 273.
    Wyoming Medicaid Preferred Drug List (PDL), June 8, 2026Incretin Mimetics (GLP-1 Receptor Agonists), clinical criteriaWyoming Medicaid (Optum Rx)retrieved 2026-11-10↩“A 90 day trial of failure of the preferred agent is required before approval can be given for a non-preferred agent.”
  274. 274.
    Weight Management Program & GLP-1 (AOM)Program description and eligibilityWyoming Department of Administration & Information, Employees' Group Insuranceretrieved 2026-11-10↩“This program will allow for expanded coverage of anti-obesity GLP-1 medications beyond the existing six-month lifetime limit.”
  275. 275.
    Benefit Press, Fall 2026 (Active Employee)EGI Completes Core Benefits RFP; Premium Rate IncreaseEmployees' Group Insurance (hosted by University of Wyoming Human Resources)retrieved 2026-11-10↩“Health: Cigna will remain EGI’s third-party administrator.”
  276. 276.
    State Drug Utilization DataCenters for Medicare & Medicaid Services↩
  277. 277.
    42 U.S.C. 1396r-8 (Social Security Act §1927)§1927(d)(2)(A), list of drugs subject to restrictionU.S. Government Publishing Office (govinfo), U.S. Code 2023 editionretrieved 2026-11-09↩“Agents when used for anorexia, weight loss, or weight gain.”
  278. 278.
    BALANCE Model State Medicaid Request for Applications§2.3 State ParticipationCMS Innovation Centerretrieved 2026-11-09↩“Model participation is open to all states, the District of Columbia, and all U.S. territories that participate in the Medicaid Drug Rebate Program (MDRP).”
  279. 279.
    BALANCE ModelOverview and FAQ (page last updated 09/29/2026)CMS Innovation Centerretrieved 2026-11-09↩“State Medicaid agencies can join the model beginning in May 2026 through January 1, 2027.”
  280. 280.
    BALANCE Model — FAQFAQ: impact of the BALANCE Model not launching in Medicare in 2027CMS Innovation Centerretrieved 2026-11-09↩“The Medicare GLP-1 Bridge will be extended through December 31, 2027.”
  281. 281.
    BALANCE Model — model drugsModel drugsCMS Innovation Centerretrieved 2026-11-09“All formulations of Mounjaro®, Ozempic®, Rybelsus®, and Wegovy®, the KwikPen formulation of Zepbound®, and Foundayo™.”
  282. 282.
    CMS launches voluntary model to expand access to life-changing medicines and promote healthier livingPress release, December 23, 2025CMS Newsroomretrieved 2026-11-09↩“The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027.”
  283. 283.
    BALANCE Model State Medicaid Request for Applications§2.3 State Participation (Last Modified: March 2026)CMS Innovation Centerretrieved 2026-11-09↩“States will participate in the model by responding to this state RFA by no later than July 31, 2026, and executing a SA with CMS by January 1, 2027.”
  284. 284.
    BALANCE Model State Medicaid Request for Applications§1.1 Model ScopeCMS Innovation Centerretrieved 2026-11-09↩“The CMS Innovation Center is testing this model beginning on May 1, 2026, for participating States and January 1, 2027, for participating Part D sponsors. The model will run through December 2031.”
  285. 285.
    BALANCE Model State Medicaid Request for Applications§2.3 State ParticipationCMS Innovation Centerretrieved 2026-11-09↩“States that do not join the model by January 1, 2027, may be allowed to participate in the model at CMS discretion.”
  286. 286.
    Medicare GLP-1 BridgeOverview (page last updated 07/13/2026)CMSretrieved 2026-11-09↩“Eligible beneficiaries will have a $50 copay.”
  287. 287.
    Weight loss drugs (Medicare GLP-1 Bridge)CostsMedicare.govretrieved 2026-11-09↩“You'll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug).”
  288. 288.
    Weight loss drugs (Medicare GLP-1 Bridge)Prior authorizationMedicare.govretrieved 2026-11-09↩“Your prior authorization is valid (including for refills and dose changes) through December 31, 2027”
  289. 289.
    42 CFR 423.100 — Definitions (Part D drug)Definition of Part D drug, paragraph (2)(ii)eCFR (Office of the Federal Register)retrieved 2026-11-09↩“Drugs or classes of drugs, or their medical uses, which may be excluded from coverage or otherwise restricted under Medicaid under sections 1927(d)(2) or (d)(3) of the Act, except for smoking cessation agents.”
  290. 290.
    Medicare GLP-1 Bridge — Information for Part D PlansClinical eligibilityCMSretrieved 2026-11-09↩“Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver scarring (fibrosis)”
  291. 291.
    Medicare GLP-1 Bridge — Information for Part D PlansClinical eligibilityCMSretrieved 2026-11-09↩“indication of risk reduction of major adverse cardiovascular events (MACE).”
  292. 292.
    Medicare GLP-1 Bridge — Information for Part D PlansClinical eligibility (page last modified 08/06/2026)CMSretrieved 2026-11-09↩“indications are eligible for Part D coverage.”
  293. 293.
    Foundayo — LillyDirectSelf-pay prices, footnote *Eli Lilly and Companyretrieved 2026-11-09↩“*Prices for the 2.5 mg and 5.5 mg dose are temporarily reduced through December 31, 2026.”
  294. 294.
    Foundayo full terms and conditions#journey, purchase offerEli Lilly and Companyretrieved 2026-11-09↩“Regular pricing for a 1-month supply of Foundayo: $149 (0.8 mg), $199 (2.5 mg), $299 (5.5 mg), $299 (9 mg), $349 (14.5 mg), $349 (17.2 mg).”
  295. 295.
    Foundayo full terms and conditions#journey, purchase offerEli Lilly and Companyretrieved 2026-11-09↩“Offer valid for 14.5 mg and 17.2 mg dosages of Foundayo only.”
  296. 296.
    Wegovy savings offer — NovoCareSelf pay, footnote dNovo Nordiskretrieved 2026-11-09↩“Patients pay $149 for each month of 1.5 mg, $199 per month for 4 mg and $299 per month for 9 mg and 25 mg. One month defined as 1 bottle of 30 tablets.”
  297. 297.
    Wegovy price guide (US26NC00237, November 2026)Self pay tableNovo Nordiskretrieved 2026-11-09↩“Pricing is available for local pharmacy pickup with a savings offer or home delivery, except where indicated.”
  298. 298.
    Zepbound — LillyDirectKwikPen and single-dose vial self-pay prices, footnote †Eli Lilly and Companyretrieved 2026-11-09↩“For 7.5 mg, 10 mg, 12.5 mg and 15 mg doses, prices reflect monthly cost with Zepbound Journey Program. Regular prices will apply if prescription is not refilled within 45 days ($499 for 7.5mg, $699 for 10mg, $699 for 12.5mg, and $699 for 15mg).”
  299. 299.
    Zepbound full terms and conditions#journey, Self Pay Journey ProgramEli Lilly and Companyretrieved 2026-11-09↩“Regular price for a 1-month supply of Zepbound single-dose vial or KwikPen is $299 for 2.5 mg, $399 for 5 mg, $499 for 7.5 mg, $699 for 10 mg, $699 for 12.5 mg, and $699 for 15 mg.”
  300. 300.
    Zepbound full terms and conditions#journey, Self Pay Journey ProgramEli Lilly and Companyretrieved 2026-11-09↩“You will automatically receive the $449 purchase offer on your first purchase of the 7.5 mg, 10 mg, 12.5 mg, or 15 mg Zepbound single-dose vial or KwikPen beginning February 23, 2026.”
  301. 301.
    Zepbound — LillyDirectSingle-dose vial footnote *Eli Lilly and Companyretrieved 2026-11-09↩“Month is defined as 28-days and 4 single-dose vials.”
  302. 302.
    Ozempic savings offer — NovoCareSelf pay, footnote eNovo Nordiskretrieved 2026-11-09↩“Patients new to the Ozempic® Savings Offer or Novocare® home delivery pay $199 for each month of 0.25 mg and 0.5 mg. Offer for 2 monthly fills through December 31, 2026, then $349 per month for Ozempic® 0.25 mg, 0.5 mg, or 1 mg, and $499/month for Ozempic® 2 mg.”
  303. 303.
    Ozempic pill and pen price guide (US26NC00009, May 2026)Self pay table, Ozempic pill standard offerNovo Nordiskretrieved 2026-11-09↩“1.5 mg $149/mo 4.0 mg $199/mo 9 mg $299/mo”
  304. 304.
    Wegovy savings offer — NovoCareSelf pay, footnote eNovo Nordiskretrieved 2026-11-09↩“Patients new to the Wegovy® Savings Offer or Novocare® home delivery pay $199 for each month of 0.25 mg & 0.5 mg. Offer for 2 monthly fills through December 31, 2026, then $349 per month for Wegovy® 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg, and $399 per month for Wegovy® HD (semaglutide) injection 7.2 mg.”
  305. 305.
    Mounjaro — LillyDirectSelf-pay pricesEli Lilly and Companyretrieved 2026-11-09↩“$499/month”
  306. 306.
    The cheapest GLP-1 programs online without insuranceglp1.health↩

Coverage rules change: confirm with your plan before you fill a prescription. This page is educational and is not medical advice.