Medi-Cal does not cover Wegovy or Zepbound for weight loss

Since January 1, 2026, Medi-Cal Rx does not cover any GLP-1 drug for weight loss for members 21 and older; members under 21 can get a case-by-case prior authorization review under the federal EPSDT benefit. Oral Wegovy and Foundayo are not listed on the November 1, 2026 Contract Drugs List.134

Weight loss is not an approvable reason for adults. Medi-Cal Rx reviews prior authorization requests case by case for Wegovy for cardiovascular disease, Zepbound for obstructive sleep apnea, other FDA-approved non-weight-loss uses, and weight-loss requests for members under 21 under EPSDT.139

• Wegovy: prior authorization considered when used for cardiovascular disease
• Zepbound: prior authorization considered when used for obstructive sleep apnea (OSA)
• Members under 21: weight-loss requests reviewed for medical necessity under the federal EPSDT benefit
• Request must include diagnosis, quantity/days' supply, and other products tried and why they do not meet the member's needs
• Continuation of therapy alone does not justify approval

Coverage for other uses the FDA has approved:

• Wegovy (injection), noncirrhotic MASH: Covered278
• Wegovy (injection), cardiovascular disease: Covered with prior authorization13
• Zepbound, obstructive sleep apnea: Covered with prior authorization13

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page lets state Medicaid agencies join from May 2026 through January 1, 2027, but lists no participating states, and DHCS has published no announcement; the November 1, 2026 Contract Drugs List still lists GLP-1s for weight loss as a non-benefit.111

Marketplace (ACA) plans: California's 2025-2027 benchmark plan (Kaiser Small Group HMO 30) lists weight loss programs as covered, but the CMS summary does not say whether anti-obesity medications are covered.16

Ozempic, Mounjaro, Rybelsus, Trulicity and Victoza are on the Medi-Cal Rx Contract Drugs List for type 2 diabetes; the claim must carry a type 2 diabetes diagnosis code, and Mounjaro is limited to one carton every 28 days. Medi-Cal Rx uses a single Contract Drugs List rather than a preferred/non-preferred list.83

In 2025, Medi-Cal paid for 3,077,835 GLP-1 prescriptions, $3.46 billion before rebates: 78 per 1,000 residents, against 32 across the states and DC, 1st of 51.67 It reimbursed 9 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 17 rows count as zero here and the totals are a floor.

CalPERS HMO plans that run their own pharmacy benefit, including Blue Shield of California and Kaiser Permanente, cover GLP-1s for obesity only at a BMI of 40 or higher with prior authorization; CalPERS' self-insured pharmacy benefit covers non-GLP-1 weight-loss drugs. In June 2026 CalPERS staff recommended opposing SB 1089, which would require GLP-1 obesity coverage from 2028.12

Pharmacy benefit: CalPERS (pharmacy benefit manager for self-insured plans: CVS Caremark; Blue Shield and Kaiser HMO plans manage their own pharmacy benefit).

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 2027.4243333429372232

• Medicare GLP-1 Bridge (demonstration) (active, from 2026-07-01): Runs July 1, 2026 to December 31, 2027 (extended). Outside the Part D benefit: $50 copay per one-month supply (28 or 30 days), Part D deductible does not apply, the copay does not count toward TrOOP, no low-income subsidy. Covers Foundayo, Wegovy (injection or tablet) and Zepbound KwikPen only (not Zepbound single-dose vials or pens). Eligibility: age 18+ and, when starting GLP-1 therapy, BMI ≥35; or BMI ≥30 with heart failure with preserved ejection fraction, uncontrolled hypertension, or CKD stage 3a+; or BMI ≥27 with prediabetes, prior heart attack or stroke, or symptomatic peripheral artery disease. People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease are not eligible (their Part D plan may cover GLP-1s for those conditions). Prior authorization required; valid through Dec 31, 2027 unless the patient changes GLP-1s.2930312237383940413635
• BALANCE Model — Medicare Part D component (not launching in 2027; future implementation described by CMS only as 'potential'): Originally announced to launch in Part D in January 2027. CMS's BALANCE page FAQ now refers to 'the BALANCE Model not launching in Medicare in 2027' and extends the Bridge through Dec 31, 2027 to collect data 'ahead of potential implementation of BALANCE in Part D'. No new start date is published.242622

In 2024, Medicare Part D drug plans paid for 1,865,079 GLP-1 claims from prescribers in California, $2.17 billion in total drug cost.68

The lowest price among the programs that ship to every state is WellMedr: $492 for 12 months ($41 a month); $99 month to month, fees in.72 Includes a sale seen on November 5, 2026; the price returns to the standing price when it ends. The cheapest programs, ranked, or every program, ranked on our score.

Prices are what each program charged at its own checkout, fees in, with the total due for the plan length first. Compounded GLP-1s are prepared by a pharmacy to a prescription, and they are not FDA-approved; the section on compounding explains what that means.

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

29 more programs we rank ship to fewer than 50 states, or don’t say how many. We don’t record which states they leave out, so check California on their sites: Embody, Collective, SnagRx, Enhanced, Direct Meds, Gala Health, GobyMeds, CoreAge Rx, Maximus Tribe, Brightmeds, SkinnyRx, Willow, Strut Health, Enhance MD, LumiMeds, VivioMD, MEDGm, MyDrHank, Zevay, LevelsRx, Hume Care, ReadyRx, Hers, Luvo Health, Remedy Meds, Hims, DudeMeds, G-Plans and Found.

The makers also sell some brand-name GLP-1s for cash, at the same price in every state, with a prescription:

These are standing prices. The Zepbound and Wegovy rankings list each dose and the terms of each offer.

Compounded GLP-1s are prepared by a pharmacy to a prescription. They are not FDA-approved: the FDA doesn’t review their safety, effectiveness or quality before they’re sold, and they are not the same as Wegovy or Zepbound. Formulas can differ from one pharmacy to the next, and some add ingredients such as vitamin B12.7374 Compounding pharmacies are licensed and inspected by state boards of pharmacy; outsourcing facilities (503B) also register with the FDA and are inspected by it. The FDA can issue warning letters when either breaks rules on safety or sterility.

The FDA’s register lists 8 outsourcing facilities (503B) in California, as of November 6, 2026; 4 show no inspection date and 4 were issued a Form 483.69

FDA warning letters naming a GLP-1, sent to a company in California:70

6 older letters are on the FDA status tracker.