Indiana Medicaid does not cover Wegovy or Zepbound for adult weight loss

Indiana Medicaid excludes drugs used to promote weight loss for adults, and its prior authorization criteria state that Wegovy (injection and tablets) and Zepbound are not covered exclusively for weight loss. Members under 21 may get Wegovy or Saxenda for weight loss with prior authorization through EPSDT, decided case by case. On July 30, 2026, the governor directed FSSA to join the federal BALANCE model to cover select GLP-1s for eligible members with obesity; FSSA has not yet published the eligibility criteria or a start date.134569

Optum Rx publishes the Indiana Medicaid GLP-1 prior authorization criteria (dated July 1, 2026). Wegovy and Zepbound are approved only for the uses below, not for weight loss alone. The DUR Board approved revised GLP-1 criteria in October 2026, effective for requests submitted on or after Jan. 1, 2027.34568

• Wegovy injection or tablets, cardiovascular path: age 45 or older, BMI of 27 or more, a prior heart attack, stroke or symptomatic peripheral arterial disease, on guideline-directed heart therapy unless the prescriber justifies otherwise, no type 1 or type 2 diabetes, used with a reduced-calorie diet and more physical activity; approved for 1 year. The tablets also need a medical reason to use them instead of the injection.
• Wegovy injection, MASH path: age 18 or older, MASH confirmed by liver biopsy (F2 to F3 fibrosis, no cirrhosis) or by a recent elastography test, prescribed by or with an endocrinologist, gastroenterologist or hepatologist.
• Zepbound: age 18 or older, moderate to severe obstructive sleep apnea (AHI of 15 or more on a sleep study), BMI of 30 or more, no type 1 or type 2 diabetes and HbA1c under 6.5%, used with a reduced-calorie diet and more physical activity, at most 15 mg a week; renewal needs at least 5% weight loss from baseline.
• Diabetes GLP-1s (for example Ozempic): age 18 or older, a type 2 diabetes diagnosis, a 90-day trial of metformin or a reason it cannot be used, and a baseline HbA1c from the last 90 days. Ozempic and Victoza also have a MASH or MASLD path.
• Under 21 (EPSDT): Wegovy or Saxenda for weight loss may be approved case by case; requests should include a diagnosis of morbid obesity with comorbid conditions and documentation of nutritional counseling or weight-loss programs, reassessed every six months.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults 45 or older with cardiovascular disease and obesity or overweight: Covered with prior authorization3
• Wegovy (injection), MASH with moderate to advanced liver fibrosis (injection only): Covered with prior authorization3
• Wegovy tablets, cardiovascular risk reduction in adults 45 or older with cardiovascular disease and obesity or overweight: Covered with prior authorization5
• Zepbound, moderate to severe obstructive sleep apnea with obesity: Covered with prior authorization4

What changed, and when:

CMS BALANCE model: On July 30, 2026, Gov. Mike Braun directed FSSA to participate in CMS's BALANCE model for GLP-1s for Medicaid members with obesity. CMS's model page (updated Sept. 29, 2026) still names no participating states, and the state says eligibility criteria and timing will be announced when the agreement is finalized.910

Since Jan. 1, 2026, GLP-1 drugs used for weight loss are no longer covered under the State of Indiana employee pharmacy benefit, which CVS Caremark runs for all three medical plans. The 2027 open enrollment guide lists no change to this.1112

Pharmacy benefit: Anthem (medical, National BlueCard PPO network); CVS Caremark (pharmacy benefit manager).

Marketplace (ACA) plans: Indiana's essential health benefits benchmark plan for 2025 to 2027, an Anthem small-group PPO, excludes any drug that is primarily for weight loss.14

On the Statewide Uniform Preferred Drug List in effect from Aug. 1, 2026, Ozempic, Trulicity, Victoza and generic liraglutide are preferred and Mounjaro and Rybelsus are non-preferred. Every GLP-1 in the class, preferred or not, needs prior authorization, and the list applies to both fee-for-service and managed care plans.23

In 2025, Indiana Medicaid paid for 188,627 GLP-1 prescriptions, $204.0 million before rebates: 27 per 1,000 residents, against 32 across the states and DC, 22nd of 51.64 It reimbursed 8 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 41 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 2027.3940303126341929

• 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.2627281934353637383332
• 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.212319

In 2024, Medicare Part D drug plans paid for 559,402 GLP-1 claims from prescribers in Indiana, $734.6 million in total drug cost.65

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.69 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 Indiana 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 B12.7071 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 Indiana’s board of pharmacy or attorney general on their own sites.1617

The FDA’s register lists 0 outsourcing facilities (503B) in Indiana, as of November 6, 2026.66

FDA warning letters naming a GLP-1, sent to a company in Indiana:67