ND Medicaid does not cover Wegovy or Zepbound for weight loss

ND Medicaid does not cover GLP-1 or GIP/GLP-1 drugs, such as Wegovy, Zepbound and Saxenda, for weight loss or obesity. For obesity it covers phentermine, bupropion, naltrexone and topiramate without prior authorization when the prescription carries the matching diagnosis code. The same pharmacy rules apply to traditional Medicaid and Medicaid Expansion pharmacy claims.12414

There is no prior authorization path for weight loss. Wegovy and Zepbound can be approved, with prior authorization, only for other uses: Wegovy for cardiovascular risk reduction or MASH, and Zepbound (and semaglutide) for obstructive sleep apnea. Approvals last 12 months.1112131

• Cardiovascular risk reduction (semaglutide preferred; Mounjaro and Wegovy tablets non-preferred): age 55 to under 75, no diabetes, an initial BMI of 27 or more and under 35, a prior heart attack, or prior stroke and peripheral arterial disease, current lipid-lowering and antiplatelet therapy, and tobacco cessation counseling in the past year for current tobacco users.
• Wegovy injection for cardiovascular risk or MASH is authorized only after the member tolerates a dose escalation to 2 mg of Ozempic injection.
• Mounjaro or Wegovy tablets for cardiovascular risk need a failed 12-month trial of semaglutide injection.
• MASH (semaglutide injection and brand Victoza preferred): prescribed by or with an endocrinologist, gastroenterologist or hepatologist, and moderate to severe fibrosis (F2 or F3) shown by biopsy or a listed noninvasive test.
• Obstructive sleep apnea (semaglutide or tirzepatide): prescribed by or with a sleep specialist, moderate to severe OSA (AHI over 15 on an in-lab sleep study), no type 2 diabetes, a BMI of 30 or more, and a failed 6-month trial of CPAP with a weight management program in the past year.
• Zepbound for sleep apnea also needs at least 6 months of a comprehensive weight management program with semaglutide (or phentermine or another listed drug if semaglutide is not tolerated).

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in adults 55 to under 75 without diabetes, with an initial BMI of 27 to under 35 and a prior heart attack or stroke with peripheral arterial disease: Covered with prior authorization11
• Wegovy (injection), MASH with moderate to severe (F2 or F3) liver fibrosis: Covered with prior authorization12
• Zepbound, moderate to severe obstructive sleep apnea in adults with obesity and without type 2 diabetes: Covered with prior authorization13
• Ozempic, antipsychotic-induced weight gain (Ozempic injection and brand Victoza, with the matching diagnosis code): Covered3

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no ND Medicaid announcement that North Dakota has joined.15

The NDPERS health plan, insured by Sanford Health Plan, covers GLP-1 drugs only for people diagnosed with diabetes, NDPERS's executive director told legislators in January 2025, and its 2026 to 2027 coverage summary mentions GLP-1s only for a diabetic diagnosis. A 2025 bill that would have required the plan to cover at least two anti-obesity drugs failed in the House. The plan's certificate excludes appetite suppressants.161718192021

Pharmacy benefit: Sanford Health Plan (medical and pharmacy benefits).

Marketplace (ACA) plans: North Dakota's essential health benefits benchmark plan, in effect since plan year 2025, includes coverage of GLP-1 and GIP drugs for preventing diabetes and treating insulin resistance, metabolic syndrome or morbid obesity. It applies to individual and small-group plans, not to NDPERS. Insurers may use prior authorization and cost sharing.2627

On the preferred drug list effective Oct. 1, 2026, Ozempic injection and tablets, Rybelsus, Trulicity and brand Victoza are preferred with no prior authorization. Mounjaro is the preferred tirzepatide product but needs prior authorization: a 90-day trial of Trulicity and Ozempic injection with other diabetes drugs that did not reach goal, plus a specialist prescriber or diabetes education.5678910

In 2025, ND Medicaid paid for 3,037 GLP-1 prescriptions, $2.5 million before rebates: 4 per 1,000 residents, against 32 across the states and DC, 51st of 51.75 It reimbursed 4 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 50 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 2027.5051414237453040

• 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.3738393045464748494443
• 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.323430

In 2024, Medicare Part D drug plans paid for 53,339 GLP-1 claims from prescribers in North Dakota, $61.5 million in total drug cost.76

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.80 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 North Dakota 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 B12.8182 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 North Dakota, as of November 6, 2026.77