New York Medicaid does not cover Wegovy or Zepbound for weight loss

NYRx does not cover GLP-1 drugs when they are used for weight loss; New York regulation excludes drugs used for weight loss, and NYRx says weight loss has never been a Medicaid-covered indication.123

For type 2 diabetes, preferred GLP-1s pay without a separate prior authorization when the required diagnosis is in the member's Medicaid claim history; non-preferred GLP-1s need prior authorization. NYRx pays for only one GLP-1 (and one strength) at a time, and a GLP-1 taken with a DPP-4 inhibitor needs prior authorization.54

• Diagnosis of an FDA-approved or compendia-supported indication that is also a Medicaid-covered indication (weight loss is excluded)
• Non-preferred GLP-1s (Mounjaro, Rybelsus, Ozempic tablets, generic liraglutide, Soliqua, Xultophy) require prior authorization
• Prior authorization for a GLP-1 used together with a DPP-4 inhibitor
• Only one GLP-1 or one strength at a time; a new fill rejects while more than 25% of the current fill remains

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction (established cardiovascular disease): Covered with prior authorization under the NYRx Drug Utilization Review program: confirmed cardiovascular disease, BMI of 40 or higher, participation in lifestyle changes, and a limit of two treatment attempts per lifetime.671
• Zepbound, moderate to severe obstructive sleep apnea with obesity: Covered with prior authorization under the NYRx Drug Utilization Review program: confirmed obstructive sleep apnea, BMI of 40 or higher, participation in lifestyle changes, and a limit of two treatment attempts per lifetime.871
• Wegovy (injection), MASH (metabolic dysfunction-associated steatohepatitis): No NYRx document opened for this research mentions MASH coverage for Wegovy.

What changed, and when:

CMS BALANCE model: CMS says state Medicaid agencies can join BALANCE from May 2026 through January 1, 2027, but neither CMS nor New York has published that New York is participating; NYRx's September 2026 overview still excludes weight loss.91

The Empire Plan's Advanced Flexible Formulary preferred drug list puts Wegovy, Zepbound and, as of October 2026, Foundayo under Anti-Obesity Agents, each requiring prior authorization; Wegovy and Zepbound were already listed this way in January 2026.101112

Pharmacy benefit: CVS Caremark.

Marketplace (ACA) plans: New York's EHB benchmark plan (Oxford EPO, in use for plan years 2025 to 2027) lists weight loss programs as not covered but does not name anti-obesity drugs as covered or excluded.1617

NYRx covers GLP-1 drugs for type 2 diabetes. On the October 22, 2026 Preferred Drug List, Ozempic pen, Trulicity, Victoza and exenatide are preferred; Mounjaro, Rybelsus, Ozempic tablets, generic liraglutide, Soliqua and Xultophy are non-preferred and need prior authorization. Every drug in the class must have a Medicaid-covered diagnosis on file.45

In 2025, New York Medicaid paid for 810,636 GLP-1 prescriptions, $936.4 million before rebates: 41 per 1,000 residents, against 32 across the states and DC, 14th of 51.64 It reimbursed 7 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 37 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 1,473,609 GLP-1 claims from prescribers in New York, $1.91 billion 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.

We may earn a commission when you sign up through some links. It never changes our order or scores. How we make money

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 New York 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 New York’s board of pharmacy or attorney general on their own sites.

The FDA’s register lists 2 outsourcing facilities (503B) in New York, as of November 6, 2026; 1 show no inspection date and 1 were issued a Form 483.66

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