Michigan Medicaid covers GLP‑1s for weight loss, with prior authorization

Since Jan. 1, 2026, Michigan Medicaid covers GLP-1 drugs prescribed only for weight loss under much stricter prior authorization required by the state's 2026 budget: the patient must be classified as morbidly obese (for adults, for example, a baseline BMI of 40 or more), must first try or be unable to take all five types of preferred non-GLP-1 weight-loss drugs, and the GLP-1 must be used only to avoid the need for bariatric surgery. On the Nov. 1, 2026 preferred drug list, Wegovy (pen, tablet and HD), Zepbound, Saxenda, generic liraglutide and Foundayo are all non-preferred in the anti-obesity class. The rules apply to fee-for-service and Medicaid health plan members.1239

MDHHS's clinical criteria, posted by its pharmacy vendor Prime Therapeutics, set separate prior authorization rules for GLP-1s used only for weight loss, for Wegovy's cardiovascular and MASH uses, for Zepbound's sleep apnea use, and for the diabetes GLP-1s.34567

• Weight loss only (Wegovy pen, tablet and HD, Zepbound, Saxenda or generic liraglutide, Foundayo): an allergy, contraindication or unacceptable side effects with, or a trial and failure of, all five types of preferred weight-loss drugs (benzphetamine, diethylpropion, orlistat, phendimetrazine and phentermine products).
• Weight loss only: the prescriber attests that the patient is classified as morbidly obese (for adults, for example, a baseline BMI of 40 or more; for ages 12 to 17, by CDC growth charts), that all other clinically appropriate weight-loss interventions have failed, and that the GLP-1 is used only to avert the need for bariatric surgery.
• Weight loss only: age 18 or older for Zepbound, Wegovy tablets and Wegovy HD; age 12 or older for Wegovy pens, Saxenda or liraglutide and Foundayo; part of a treatment plan with diet and activity; no MTC or MEN 2, pregnancy or lactation; no DPP-4 inhibitor at the same time. Approval lasts 6 months; renewal for adults needs at least 5% weight loss kept from baseline.
• Wegovy for cardiovascular risk reduction (pen or tablet): age 18 or older, a baseline BMI of 27 or more and established cardiovascular disease such as a prior heart attack, prior stroke or peripheral arterial disease; 6-month approvals.
• Wegovy for MASH: age 18 or older, a baseline BMI of 27 or more and noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3); renewal needs at least 5% weight loss kept from baseline.
• Zepbound for obstructive sleep apnea: age 18 or older, a baseline BMI of 27 or more and a documented diagnosis of moderate to severe obstructive sleep apnea; renewal needs at least 5% weight loss kept from baseline.
• Diabetes GLP-1s (Mounjaro, Ozempic, Trulicity, Victoza, Rybelsus): a type 2 diabetes diagnosis, stopping other GLP-1s and DPP-4 inhibitors; non-preferred drugs also need a trial of a preferred one; approved for 1 year.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults with established cardiovascular disease and a BMI of 27 or more: Covered with prior authorization24
• Wegovy tablets, cardiovascular risk reduction in adults with established cardiovascular disease and a BMI of 27 or more: Covered with prior authorization24
• Wegovy (injection), noncirrhotic MASH with moderate to advanced liver fibrosis: Covered with prior authorization25
• Zepbound, moderate to severe obstructive sleep apnea in adults with a BMI of 27 or more: Covered with prior authorization26

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page lists no participants, and we found no MDHHS announcement that Michigan has joined.15

The Optum Rx formulary for State Health Plan PPO members (effective July 1, 2026) and the one for 2027 list Wegovy, Wegovy HD, Zepbound, Saxenda and Foundayo in Tier E, which the formulary labels "Excluded" and describes as drugs that may not be covered or may need prior authorization. Mounjaro and Ozempic are Tier 2 with prior authorization. The state's Blue Care Network HMO option says it has not covered Saxenda, Wegovy or Zepbound since Jan. 1, 2025.16171819

Pharmacy benefit: Blue Cross Blue Shield of Michigan (medical); Optum Rx (prescription drugs).

Marketplace (ACA) plans: Michigan's essential health benefits benchmark plan for 2022 onward, based on a Priority Health HMO certificate, excludes drugs used for weight reduction.23

On the Nov. 1, 2026 preferred drug list, Mounjaro, the Ozempic pens, Trulicity and Victoza are preferred; Rybelsus, the Ozempic tablets, Bydureon BCise and generic exenatide and liraglutide are non-preferred. All of them need clinical prior authorization that requires a type 2 diabetes diagnosis. MDHHS said the 2026 change did not alter coverage for uses other than obesity.1071

In 2025, Michigan Medicaid paid for 606,749 GLP-1 prescriptions, $680.3 million before rebates: 60 per 1,000 residents, against 32 across the states and DC, 3rd of 51.71 It reimbursed 9 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 13 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 2027.4647373833412636

• 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.3334352641424344454039
• 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.283026

In 2024, Medicare Part D drug plans paid for 768,388 GLP-1 claims from prescribers in Michigan, $1.00 billion in total drug cost.72

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.76 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 Michigan 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 B12.7778 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 Michigan, as of November 6, 2026.73