Health First Colorado does not cover Wegovy or Zepbound for weight loss

Health First Colorado does not cover medications prescribed for weight loss: Appendix P lists weight-loss drugs, including Saxenda, as not a covered benefit, and the preferred drug list says prior authorization for GLP-1s prescribed solely for weight loss will not be approved. Wegovy (pen or tablet) can be approved with prior authorization only to lower cardiovascular risk in adults with heart disease and overweight or obesity, or for MASH, and Zepbound only for moderate to severe obstructive sleep apnea with obesity. Foundayo does not appear on the preferred drug list.1236

The GLP-1 criteria sit on HCPF's preferred drug list, which applies to fee-for-service members and not to members of Rocky Mountain Health HMO or Denver Health Medicaid Choice. Prior authorization for a GLP-1 prescribed solely for weight loss will not be approved.123520

• Wegovy (pen or tablet), cardiovascular path: age 18 or older, established cardiovascular disease (heart attack, stroke or symptomatic peripheral arterial disease) with a BMI of 25 or more, no type 2 diabetes diagnosis, prescribed to lower the risk of major cardiovascular events, and counseling on diet and exercise.
• GLP-1s FDA-labeled for MASH: a MASH diagnosis with F2 to F3 fibrosis confirmed by biopsy or imaging, no cirrhosis or other significant liver disease, the FDA-labeled minimum age, and a prescriber who is or consults a gastroenterologist, endocrinologist, obesity medicine specialist, hepatologist or liver transplant provider.
• Zepbound: age 18 or older, the multidose KwikPen unless the prescriber explains the need for the vial or single-use pen, moderate to severe obstructive sleep apnea confirmed by an FDA-approved sleep test with an apnea-hypopnea index of 15 or more, a BMI of 30 or more, not pregnant, a sleep specialist prescriber or consultation, lifestyle counseling, and a failed 6-month trial of CPAP or a reason it cannot be used; renewal for one year needs an in-person re-evaluation and documented improvement.
• Diabetes GLP-1s: preferred products may be approved with a type 2 diabetes diagnosis; non-preferred products need an FDA-labeled diagnosis other than weight loss and a trial and failure of three preferred drugs.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight (pen): Covered with prior authorization2
• Wegovy tablets, cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight: Covered with prior authorization29
• Wegovy (injection), MASH with stage F2 to F3 liver fibrosis: Covered with prior authorization2010
• Zepbound, moderate to severe obstructive sleep apnea with obesity: Covered with prior authorization38

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no HCPF announcement that Colorado has joined.11

Since May 1, 2026, the state employee plans cover GLP-1s for weight loss for members who meet the plan criteria. Cigna plan members get Zepbound for weight loss unless a medical reason calls for another drug, and Kaiser Permanente members go through Kaiser's own pre-authorization. The state had removed weight-loss coverage on July 1, 2025, keeping only members already taking the drugs, at a $120 copay; that grandfathering ended on May 1, 2026.1213

Pharmacy benefit: Department of Personnel & Administration; Cigna (medical) with MedImpact running the GLP-1 program for Cigna members; Kaiser Permanente.

Marketplace (ACA) plans: Colorado's essential health benefits benchmark plan for 2027 and later excludes drugs for the treatment of weight control. The 2027 update added abortion coverage and no anti-obesity drug coverage.1718

On the preferred drug list effective Oct. 1, 2026, the Ozempic pen and tablet, Mounjaro, Trulicity, Victoza and Teva's liraglutide are preferred and may be approved for members with type 2 diabetes. Rybelsus, exenatide and other liraglutide pens are non-preferred and need prior authorization, including a trial of three preferred drugs.41

In 2025, Health First Colorado paid for 118,610 GLP-1 prescriptions, $125.3 million before rebates: 20 per 1,000 residents, against 32 across the states and DC, 32nd of 51.67 It reimbursed 8 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 40 rows count as zero here and the totals are a floor.

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 232,148 GLP-1 claims from prescribers in Colorado, $297.0 million 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.

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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 Colorado 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 4 outsourcing facilities (503B) in Colorado, as of November 6, 2026; 0 show no inspection date and 4 were issued a Form 483.69

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