Florida Medicaid does not cover Wegovy or Zepbound for weight loss

Marketplace (ACA) plans: Florida's 2025-2027 benchmark plan (Florida Blue BlueOptions 5462) lists weight loss programs and bariatric surgery as not covered; the CMS summary does not address anti-obesity drugs.12

Florida Medicaid's prescribed drug coverage policy lists weight control medications as not covered, and none of Wegovy, Zepbound, Saxenda or Foundayo appears on the Preferred Drug List effective October 1, 2026.12

AHCA's GLP-1 criteria (revised October 1, 2026) approve these drugs for type 2 diabetes only, for up to one year.3

• Age 18 or older for Ozempic and Rybelsus; age 10 or older for Mounjaro, Trulicity and Victoza
• Diagnosis of type 2 diabetes mellitus
• HbA1c of 6.5% or higher measured within the past 6 months (documentation required)
• Trial and failure of metformin within the past 2 years unless contraindicated or not tolerated (documentation required)
• For non-preferred agents: previous trial with insufficient response, adverse reaction or contraindication to preferred GLP-1 agents
• Continuation: documentation of improved clinical response (e.g., decline in HbA1c) and no treatment-restricting adverse effects

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction: Covered with prior authorization4
• Wegovy (injection), MASH (noncirrhotic, F2-F3 fibrosis): Covered with prior authorization4
• Zepbound, obstructive sleep apnea: Covered with prior authorization4

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and no AHCA announcement of Florida joining was found.6

Ozempic (injection and tablets), Mounjaro, Rybelsus and Trulicity are preferred agents that need a clinical prior authorization for type 2 diabetes; Victoza, generic liraglutide and exenatide are non-preferred.32

In 2025, Florida Medicaid paid for 132,696 GLP-1 prescriptions, $127.7 million before rebates: 6 per 1,000 residents, against 32 across the states and DC, 46th of 51.59 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.

Members accepted into the Weight Management Program get coverage of FDA-approved weight management medications, including Wegovy (injection and oral), Zepbound, Saxenda and Foundayo; the 2027 program is open to 2,000 participants who meet BMI and other criteria.78

Pharmacy benefit: Florida Department of Management Services, Division of State Group Insurance (pharmacy benefit manager: Optum Rx).

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 2027.3435252621291424

• 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.2122231429303132332827
• 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.161814

In 2024, Medicare Part D drug plans paid for 1,448,671 GLP-1 claims from prescribers in Florida, $1.85 billion in total drug cost.60

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.64 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 Florida 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 B12.6566 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 Florida’s board of pharmacy or attorney general on their own sites.

The FDA’s register lists 16 outsourcing facilities (503B) in Florida, as of November 6, 2026; 7 show no inspection date and 8 were issued a Form 483.61

FDA warning letters naming a GLP-1, sent to a company in Florida:62

10 older letters are on the FDA status tracker.