Georgia Medicaid does not cover Wegovy or Zepbound for weight loss

Georgia Medicaid and PeachCare for Kids do not list Wegovy, Zepbound or Foundayo on the preferred drug list or among the drugs with prior authorization criteria, and Peach State Health Plan, a Georgia Medicaid managed care plan, excludes drugs prescribed for weight loss. The one GLP-1 with a weight-related path is Saxenda: DCH says it is not covered for members 18 or older and can be approved with prior authorization only for members 12 to 17 who have high cholesterol and are already on a cholesterol drug.12358

DCH publishes fee-for-service prior authorization criteria for each class; Saxenda falls under 'Antihyperlipidemics, Other' and the diabetes GLP-1s under 'Antidiabetic Agents'.34

• Saxenda: ages 12 to 17 only, with a diagnosis of hypercholesterolemia or hyperlipidemia, currently taking lipid-lowering drugs, weight over 60 kg and a starting BMI of 30 or more, used with a reduced-calorie diet and more physical activity, after an inadequate response, allergy, contraindication, interaction or intolerable side effect with Xenical (orlistat); approved for 1 year.
• Mounjaro: age 10 or older with type 2 diabetes and an HbA1c of 6.5% or higher, to improve blood sugar control.
• Ozempic: age 18 or older with type 2 diabetes and an HbA1c of 6.5% or higher, for blood sugar control, chronic kidney disease risk reduction or cardiovascular risk reduction in established cardiovascular disease.
• Victoza and generic liraglutide: age 10 or older with type 2 diabetes and an HbA1c of 6.5% or higher (cardiovascular use from age 18).
• Rybelsus and Trulicity (non-preferred): type 2 diabetes plus a prior trial of, or a reason not to use, the preferred options named in the criteria.

What changed, and when:

CMS BALANCE model: CMS says state Medicaid agencies can join the BALANCE Model from May 2026 through Jan. 1, 2027, and we found no DCH announcement that Georgia has joined.9

SHBP says coverage of weight-loss medications continues in 2027 under each plan's coverage rules, and every prescription needs prior authorization; for the Anthem and UnitedHealthcare options, requests go to Express Scripts from Jan. 1, 2027. From Feb. 1, 2026, Anthem and UnitedHealthcare members had to get weight-loss prescriptions from 9amHealth providers; since Oct. 1, 2026 the 9amHealth program is optional and any physician can prescribe, subject to prior authorization.101112131415

Pharmacy benefit: Express Scripts (pharmacy benefits for the Anthem and UnitedHealthcare plan options from Jan. 1, 2027; CVS Caremark through 2026); Kaiser Permanente runs its own plan's pharmacy benefits.

Marketplace (ACA) plans: Georgia's essential health benefits benchmark plan is a Humana Employers Health Plan of Georgia small-group HMO; the plan document CMS posts excludes any drug used for weight control.2021

On the Nov. 1, 2026 preferred drug list, Ozempic injection, Mounjaro, Victoza and the Teva generic liraglutide are preferred, and Rybelsus and Trulicity are non-preferred. All of them need prior authorization for a type 2 diabetes diagnosis. Mounjaro and Ozempic moved from non-preferred to preferred on July 1, 2026.1467

In 2025, Georgia Medicaid paid for 51,845 GLP-1 prescriptions, $49.6 million before rebates: 5 per 1,000 residents, against 32 across the states and DC, 49th of 51.70 It reimbursed 8 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 35 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 2027.4546363732402535

• 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.3233342540414243443938
• 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.272925

In 2024, Medicare Part D drug plans paid for 755,901 GLP-1 claims from prescribers in Georgia, $970.2 million in total drug cost.71

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.75 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 Georgia 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 B12.7677 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 0 outsourcing facilities (503B) in Georgia, as of November 6, 2026.72

FDA warning letters naming a GLP-1, sent to a company in Georgia:73