Maryland Medicaid does not cover Wegovy or Zepbound for weight loss

Maryland Medicaid does not cover drugs for weight loss: a state regulation excludes agents used for weight control, and the Department of Health says this applies to fee-for-service and all HealthChoice managed care plans. Wegovy (injection or tablet) is covered with prior authorization only for adults with established cardiovascular disease and overweight or obesity, the Wegovy injection also for MASH with F2 to F3 liver fibrosis, and Zepbound only for moderate to severe obstructive sleep apnea with obesity. Saxenda and Foundayo have no Maryland Medicaid clinical criteria. A 2026 law lets, but does not require, Maryland Medicaid cover obesity treatment, including weight-management drugs, from Jan. 1, 2027; we found no Department of Health notice that it will.678412311

The Office of Pharmacy Services sets the clinical criteria and one Wegovy and Zepbound prior authorization form; managed care plans must cover Wegovy under the same fee-for-service criteria.1234510

• Wegovy injection, cardiovascular path: age 18 or older, BMI of 27 or more with height and weight from the last 90 days, established atherosclerotic cardiovascular disease (prior heart attack, prior stroke, or symptomatic peripheral arterial disease), prescribed by or with a cardiologist, no other GLP-1 at the same time.
• Wegovy injection, MASH path: age 18 or older, non-cirrhotic MASH with F2 or F3 fibrosis confirmed by biopsy or a listed non-invasive test in the last 180 days, prescribed by or with a gastroenterologist or hepatologist, no other MASH drug at the same time.
• Wegovy injection: at most 4 pens per 28 days; approved for 4 months at first, then every 6 months.
• Wegovy tablets: cardiovascular path only, with the same age, BMI, cardiology and cardiovascular-disease requirements; at most 1 tablet a day; approved for 4 months, renewals for 6 months.
• Zepbound: age 18 or older, moderate to severe obstructive sleep apnea with an apnea-hypopnea index of at least 15 on a sleep study, BMI of 30 or more, prescribed by or with a sleep specialist, pulmonologist or other provider experienced in sleep apnea, no other GLP-1 at the same time; at most 4 pens per 28 days; approved for 6 months, renewals denied if BMI falls below 30, and repeat sleep-apnea documentation needed after 12 months.
• The prior authorization form asks the prescriber to attest a trial of weight loss management in the past 6 months and use with a reduced-calorie diet and exercise plan.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight: Covered with prior authorization14
• Wegovy (injection), MASH with moderate to advanced liver fibrosis (injection only): Covered with prior authorization17
• Wegovy tablets, cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight: Covered with prior authorization3
• Zepbound, moderate to severe obstructive sleep apnea with obesity: Covered with prior authorization25

What changed, and when:

CMS BALANCE model: CMS says state Medicaid agencies can join BALANCE from May 2026 through Jan. 1, 2027, but its model page names no participating states, and we found no Maryland Department of Health announcement that Maryland has joined.13

The State of Maryland prescription plan, run by MedImpact, lists anorectics, meaning any drug used for weight loss, as not covered for the 2026 plan year. In a February 2025 letter, the Department of Budget and Management said Wegovy is eligible for its cardiovascular use and that Zepbound was not yet covered for sleep apnea. In March 2026 it opposed a bill (HB 1565) that would have required the plan to cover anti-obesity drugs; the bill did not pass.14151617

Pharmacy benefit: Maryland Department of Budget and Management, Employee Benefits Division; MedImpact Healthcare Systems (prescription benefit manager).

Marketplace (ACA) plans: Maryland's essential health benefits benchmark plan for 2025 to 2027, a CareFirst BlueChoice small-group HMO, excludes medical or surgical treatment for reducing or controlling weight except the obesity services it lists (surgery for morbid obesity and obesity care for members under 19); it has no separate rule for weight-loss drugs.20

On the Maryland Medicaid preferred drug list effective July 1, 2026 (updated Aug. 6, 2026), Ozempic, Mounjaro, Trulicity and liraglutide (Victoza) are preferred in the incretin class; Rybelsus is non-preferred and needs prior authorization.9

In 2025, Maryland Medicaid paid for 145,243 GLP-1 prescriptions, $141.3 million before rebates: 23 per 1,000 residents, against 32 across the states and DC, 26th of 51.68 It reimbursed 6 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 45 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 2027.4344343530382333

• 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.3031322338394041423736
• 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.252723

In 2024, Medicare Part D drug plans paid for 289,814 GLP-1 claims from prescribers in Maryland, $407.2 million in total drug cost.69

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.73 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 Maryland 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 B12.7475 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 Maryland’s board of pharmacy or attorney general on their own sites.21

The FDA’s register lists 1 outsourcing facilities (503B) in Maryland, as of November 6, 2026; 1 show no inspection date and 0 were issued a Form 483.70

FDA warning letters naming a GLP-1, sent to a company in Maryland:71