DC Medicaid does not cover Wegovy or Zepbound for weight loss

DC Medicaid does not cover GLP-1 drugs for weight loss: the DHCF preferred drug list effective Sept. 18, 2026 names anti-obesity drugs among the excluded classes. MedStar Family Choice DC, one of the DC Healthy Families managed care plans, covers Wegovy only to lower cardiovascular risk or for MASH and Zepbound only for obstructive sleep apnea, and its criteria say neither can be approved for weight management.1456

There is no weight-loss pathway for GLP-1 drugs in DC Medicaid. In fee-for-service, non-preferred drugs need prior authorization. MedStar Family Choice DC publishes its own GLP-1 criteria for diabetes, cardiovascular risk, MASH and sleep apnea.2567

• Diabetes GLP-1s at MedStar Family Choice DC (Mounjaro, Ozempic, Trulicity): a confirmed type 2 diabetes diagnosis and an A1c or continuous glucose monitor reading from the last 90 days; either an A1c of 7.5% or more (or time in range of 60% or less), or established cardiovascular disease with a BMI of 27 or more and an A1c of 6.5% or more (or time in range of 70% or less).
• Step therapy at MedStar Family Choice DC: at least 3 months of two other diabetes drugs (such as metformin, insulin or an SGLT2 inhibitor) and at least 3 months of liraglutide, unless contraindicated or not tolerated.
• Wegovy at MedStar Family Choice DC, cardiovascular path: age 18 or older, a BMI of 27 or more, a prior heart attack, prior stroke or symptomatic peripheral arterial disease, and a prescriber who is or consults a cardiologist.
• Wegovy at MedStar Family Choice DC, MASH path: non-cirrhotic MASH with F2 or F3 fibrosis confirmed by biopsy or an approved noninvasive test in the past 180 days, prescribed by or with a gastroenterologist or hepatologist.
• Zepbound at MedStar Family Choice DC: moderate to severe obstructive sleep apnea confirmed by a sleep study (AHI of 15 or more) within 6 months, age 18 or older, a BMI of 30 or more, and no type 1 or type 2 diabetes; approvals last 6 months.
• All GLP-1s at MedStar Family Choice DC: no other GLP-1 or DPP-4 inhibitor at the same time.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in adults with established cardiovascular disease and a BMI of 27 or more (MedStar Family Choice DC): Covered with prior authorization5
• Wegovy (injection), non-cirrhotic MASH with F2 or F3 liver fibrosis in adults (MedStar Family Choice DC): Covered with prior authorization5
• Zepbound, moderate to severe obstructive sleep apnea in adults with obesity and without diabetes (MedStar Family Choice DC): Covered with prior authorization6

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no DHCF announcement that DC has joined.10

DC government employees hired on or after Oct. 1, 1987 choose among Aetna, CareFirst, Kaiser Permanente and UnitedHealthcare plans, each with its own prescription drug benefit. The 2026 DC Government Benefits Guide does not say whether GLP-1 drugs are covered for weight loss, and we found no public DCHR policy that does.11

Pharmacy benefit: DC Department of Human Resources (DCHR); medical and drug coverage through Aetna, CareFirst, Kaiser Permanente and UnitedHealthcare plans.

Marketplace (ACA) plans: DC's essential health benefits benchmark plan for 2026 to 2028, a CareFirst (GHMSI) Blue Preferred PPO small-group plan, excludes medical or surgical treatment for obesity and weight reduction, apart from listed preventive and counseling services.14

On the DHCF preferred drug list effective Sept. 18, 2026, generic liraglutide, Trulicity and Ozempic injection are the preferred GLP-1 drugs; Mounjaro, Rybelsus, Ozempic tablets and brand Victoza need prior authorization. MedStar Family Choice DC requires prior authorization for Mounjaro, Ozempic, Rybelsus and liraglutide, with a confirmed type 2 diabetes diagnosis.237

In 2025, DC Medicaid paid for 27,507 GLP-1 prescriptions, $27.9 million before rebates: 40 per 1,000 residents, against 32 across the states and DC, 15th of 51.62 It reimbursed 6 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 51 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 2027.3738282924321727

• 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.2425261732333435363130
• 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.192117

In 2024, Medicare Part D drug plans paid for 34,054 GLP-1 claims from prescribers in District of Columbia, $45.1 million in total drug cost.63

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.67 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 District of Columbia 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 B12.6869 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 District of Columbia’s board of pharmacy or attorney general on their own sites.15

The FDA’s register lists 0 outsourcing facilities (503B) in District of Columbia, as of November 6, 2026.64