Med-QUEST does not cover Wegovy or Zepbound for weight loss

Hawaii's Medicaid program, run by the Med-QUEST Division through QUEST Integration health plans, does not cover GLP-1 drugs such as Wegovy, Zepbound or Saxenda for weight loss. In February 2026 the Department of Human Services told the Legislature that one QUEST Integration plan had covered weight-loss drugs for a time but rescinded that coverage as costs rose, and AlohaCare's QUEST formulary page states that drugs for weight loss are not covered.1234

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no Hawaii announcement that Med-QUEST has joined.6

The EUTF prescription drug plan administered by CVS covers Wegovy and Zepbound as weight-loss GLP-1s. Since January 1, 2026, a first fill of any GLP-1 for diabetes or weight loss is limited to 30 days under the EUTF active and non-Medicare retiree plans. Since July 1, 2026, the HMSA plans also include the CVS Weight Management Program, a voluntary coaching program open to members whether or not they use weight-loss medication.78910

Pharmacy benefit: CVS Caremark (prescription drugs for the HMSA plans); Kaiser Permanente (its own HMO plans).

Marketplace (ACA) plans: Hawaii's essential health benefits benchmark plan for 2025 to 2027, HMSA's small-group Preferred Provider Plan 2010, excludes weight reduction programs and supplies, including prescription drugs.1213

The Department of Human Services told the Legislature that GLP-1 drugs were Med-QUEST's most expensive drug class in 2024, at $42.5 million. We could not read Med-QUEST's drug coverage pages to confirm the formulary status of each diabetes GLP-1.2

In 2025, Med-QUEST paid for 29,228 GLP-1 prescriptions, $33.5 million before rebates: 20 per 1,000 residents, against 32 across the states and DC, 31st of 51.62 It reimbursed 5 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 33 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 65,437 GLP-1 claims from prescribers in Hawaii, $99.6 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 Hawaii 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.

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

FDA warning letters naming a GLP-1, sent to a company in Hawaii:65