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

Delaware Medicaid covers drugs for weight loss with prior authorization. On the preferred drug list effective Nov. 2, 2026, the Wegovy pen, Zepbound and Foundayo are preferred obesity treatment agents, while Wegovy tablets and Saxenda are non-preferred and are approved only after two preferred products. Weight-loss approval needs a BMI of 30 or more, or a BMI of 27 to under 30 with a listed weight-related condition, plus a reduced-calorie diet and more physical activity.1451011

DMAP uses one prior authorization form, revised April 20, 2026, for GLP-1 drugs used for weight management, MASH or the prevention of major cardiovascular events. Members in a managed care plan get prior authorization through their plan, under the plan's criteria.12456789

• Weight loss: adults with a BMI of 30 or more, or children with a BMI at or above the 95th percentile for age and weight.
• Weight loss with a BMI of 27 to under 30: at least one listed condition: cardiovascular disease, heart failure, chronic kidney disease stage 3a or above, high blood pressure, high cholesterol, peripheral artery disease, moderate to severe obstructive sleep apnea (apnea-hypopnea index over 15), or type 2 diabetes.
• All uses: an FDA-approved indication, use with a reduced-calorie diet and increased physical activity, no other GLP-1 at the same time, and supporting medical records and test results.
• MASH: prescribed by or with a hepatologist or gastroenterologist, with F2 to F3 liver fibrosis confirmed by biopsy or a non-invasive test; no BMI minimum.
• Prevention of major cardiovascular events: a BMI of 27 or more and established cardiovascular disease.
• First approval lasts up to 6 months in supplies of 30 days or less. Renewal for weight loss needs at least 5% weight loss from baseline for adults (4% for adolescents) and is then granted for 6 months in supplies of up to 90 days; if more than half the lost weight is regained, renewal may be refused for at least a year.
• Non-preferred drugs (Wegovy tablets, Saxenda and others): two preferred products first.

Coverage for other uses the FDA has approved:

• Wegovy (injection), MASH with moderate to advanced liver fibrosis (F2 to F3): Covered with prior authorization6
• Wegovy (injection), prevention of major adverse cardiovascular events in members with a BMI of 27 or more and established cardiovascular disease: Covered with prior authorization7
• Zepbound, moderate to severe obstructive sleep apnea counts as a qualifying condition for members with a BMI of 27 to under 30 under the weight-loss criteria: Covered with prior authorization5

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no Delaware announcement that its Medicaid program has joined.14

The State Employee Benefits Committee voted on March 9, 2026 to keep covering GLP-1 drugs for weight management, such as Wegovy and Zepbound, with a $200 copay per 30-day supply from July 1, 2026 for non-Medicare members; the copay does not count toward the out-of-pocket maximum. Coverage goes through CVS Caremark's formulary and review, and Zepbound needs a clinical exception. Members who take a diabetes GLP-1 for diabetes keep the $32 copay.151617

Pharmacy benefit: CVS Caremark (prescription drugs); Aetna and Highmark (medical).

Marketplace (ACA) plans: Delaware's essential health benefits benchmark plan for 2025 to 2027, a Highmark Blue Cross Blue Shield Delaware small-group EPO, lists drugs for weight loss among the exclusions of its drug program.19

On the preferred drug list effective Nov. 2, 2026, Mounjaro, Ozempic injection and Trulicity are the preferred diabetes GLP-1 drugs; Rybelsus, Victoza, generic liraglutide, exenatide and Ozempic tablets are non-preferred. Every drug in the class needs prior authorization, and a non-preferred drug needs two preferred products first.3

In 2025, Delaware Medicaid paid for 55,637 GLP-1 prescriptions, $21.3 million before rebates: 52 per 1,000 residents, against 32 across the states and DC, 7th of 51.67 It reimbursed 7 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 54 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 67,256 GLP-1 claims from prescribers in Delaware, $100.7 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 Delaware 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.

We found no action on compounded GLP-1s by Delaware’s board of pharmacy or attorney general on their own sites.20

The FDA’s register lists 0 outsourcing facilities (503B) in Delaware, as of November 6, 2026.69

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