MO HealthNet covers Zepbound for weight loss, with prior authorization, but not Wegovy

MO HealthNet covers Zepbound and Foundayo for weight loss as preferred drugs under its GLP-1 obesity criteria, with prior authorization that requires a documented BMI of 30 or more, or 27 or more with a listed weight-related condition (Zepbound from age 12, Foundayo from age 18). Wegovy is non-preferred and is not covered for weight loss: MO HealthNet covers it only to lower the risk of major cardiovascular events or for MASH. Anti-obesity drugs not named in the policy, such as Saxenda, stay excluded.123456710

MO HealthNet applies one GLP-1 obesity PDL edit and one prior authorization form for all GLP-1 uses. Approvals for the obesity drugs default to 90 days.4567

• Zepbound and Foundayo (preferred): age 12 or older for Zepbound and 18 or older for Foundayo, and one of: documented use of the current preferred drug, current antipsychotic therapy, for ages 12 to 17 a baseline BMI at or above the 95th percentile for age and sex, or for adults a baseline BMI of 30 or more, a baseline BMI of 27 or more with at least one listed condition, or MASH with F2 or F3 fibrosis confirmed by biopsy or a noninvasive test.
• Listed weight-related conditions for a BMI of 27 or more: high blood pressure, dyslipidemia, obstructive sleep apnea, prediabetes (A1C 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL or a 2-hour glucose of 140 to 199 mg/dL), previous heart attack, previous stroke, symptomatic peripheral arterial disease, or type 2 diabetes.
• Wegovy (non-preferred), cardiovascular path: age 45 or older, a baseline BMI of 27 or more, a documented heart attack, stroke or symptomatic peripheral arterial disease, current drug therapy for cardiovascular disease, no diabetes diagnosis in the past 2 years with an A1C under 6.5 in the past 3 months, and no diabetes drugs in the past 2 years.
• Wegovy, MASH path: age 18 or older, MASH with F2 or F3 fibrosis confirmed by a recent biopsy or noninvasive test, current liver function tests, prescribed by or with a gastroenterologist, hepatologist or other specialist, and the same no-diabetes requirements.
• Wegovy approvals last 4 weeks at a time during dose escalation, and therapy is denied if the dose cannot reach at least 1.7 mg within 6 months.
• All GLP-1s: no other GLP-1 at the same time, and claims must stay within the listed quantity limits.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in adults 45 or older with a BMI of 27 or more and established cardiovascular disease, without diabetes: Covered with prior authorization6
• Wegovy (injection), noncirrhotic MASH with F2 or F3 liver fibrosis, without diabetes: Covered with prior authorization6
• Zepbound, obstructive sleep apnea counts as a qualifying condition for adults with a BMI of 27 or more under the obesity criteria: Covered with prior authorization4

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no MO HealthNet announcement that Missouri has joined.13

MCHCP's prescription drug benefits for state employees are administered by Express Scripts, and its preferred formulary is posted only inside the member portal. We found no public MCHCP document that states its GLP-1 weight-loss policy.14

Pharmacy benefit: Express Scripts (prescription drug benefits); Anthem (medical).

Marketplace (ACA) plans: Missouri's essential health benefits benchmark plan, an Anthem Blue Cross and Blue Shield small-group PPO, excludes any drug mainly used for weight loss.18

On the diabetes GLP-1 preferred drug list revised July 23, 2026, Mounjaro, Ozempic injection, Trulicity and Victoza are preferred, and Rybelsus is non-preferred. Each needs a documented diabetes diagnosis in the past year or documented use of the current therapy; a non-preferred drug also needs a metformin trial and trials of three preferred drugs.89

In 2025, MO HealthNet paid for 285,027 GLP-1 prescriptions, $284.8 million before rebates: 45 per 1,000 residents, against 32 across the states and DC, 11th of 51.66 It reimbursed 8 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 7 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 2027.4142323328362131

• 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.2829302136373839403534
• 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.232521

In 2024, Medicare Part D drug plans paid for 481,113 GLP-1 claims from prescribers in Missouri, $596.3 million in total drug cost.67

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.71 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 Missouri 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 B12.7273 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 Missouri’s board of pharmacy or attorney general on their own sites.19

The FDA’s register lists 3 outsourcing facilities (503B) in Missouri, as of November 6, 2026; 1 show no inspection date and 2 were issued a Form 483.68

FDA warning letters naming a GLP-1, sent to a company in Missouri:69