South Dakota Medicaid does not cover Wegovy or Zepbound for weight loss

South Dakota Medicaid does not cover drugs used for weight loss. Its 2026 preferred drug list marks the GLP-1 class "No coverage for weight loss", and its Wegovy and Zepbound prior authorization forms say neither is covered for obesity or weight management. Wegovy is covered with prior authorization only to lower the risk of major cardiovascular events or for MASH, and Zepbound only for moderate to severe obstructive sleep apnea.1234

South Dakota Medicaid has no prior authorization path for GLP-1s for weight loss. OptumRx reviews Wegovy requests only for cardiovascular risk reduction or MASH in members without diabetes, and Zepbound requests only for obstructive sleep apnea.239

• Wegovy, cardiovascular path: the form asks for the patient's BMI and an HbA1c from the last 2 months, established cardiovascular disease (a prior heart attack, prior stroke or peripheral arterial disease), the lipid-lowering and antiplatelet drugs the patient takes, and tobacco use with any cessation counseling.
• Wegovy, MASH path: fibrosis stage F2 or F3, no decompensated cirrhosis (Child-Pugh B or C), a prescriber attestation of a supervised weight management plan, prescribing by or with an endocrinologist, gastroenterologist, hepatologist or other specialist, and no other GLP-1 at the same time.
• Wegovy tablets: the form also asks whether the member had a 90-day trial and failure of Rybelsus tablets.
• Zepbound: a diagnosis of moderate to severe obstructive sleep apnea confirmed by a sleep study, the patient's BMI, participation in a supervised weight management plan, no DPP-4 inhibitor or other GLP-1 at the same time, and no personal or family history of medullary thyroid carcinoma or MEN2.
• Requests above the plan's quantity limits need a stated reason, such as titration.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in members without diabetes: Covered with prior authorization128
• Wegovy (injection), noncirrhotic MASH in members without diabetes: Covered with prior authorization126
• Zepbound, moderate to severe obstructive sleep apnea: Covered with prior authorization136

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no South Dakota Medicaid announcement that the state has joined.7

The State of South Dakota's employee health plans are administered by Wellmark Blue Cross and Blue Shield, which also administers the pharmacy benefit on its Blue Rx Value Plus formulary. The FY27 benefits guide does not state a GLP-1 weight-loss policy, and we found no public plan document that does.10

Pharmacy benefit: Wellmark Blue Cross and Blue Shield (medical and pharmacy, Blue Rx Value Plus formulary; CVS Caremark member portal).

Marketplace (ACA) plans: South Dakota's essential health benefits benchmark plan, based on a Wellmark Blue Select small-group plan, does not cover weight reduction drugs, whether or not weight reduction is medically appropriate.1314

On the 2026 preferred drug list, Mounjaro, Ozempic, Rybelsus, Trulicity and Victoza are preferred GLP-1 drugs. A GLP-1 drug not listed in the class is non-preferred and may need extra steps for approval; since September 2024 the P&T Committee has required a three-month trial of one preferred drug before a non-preferred one.158

In 2025, South Dakota Medicaid paid for 15,439 GLP-1 prescriptions, $15.6 million before rebates: 17 per 1,000 residents, against 32 across the states and DC, 38th of 51.62 It reimbursed 4 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 14 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 2027.3738282924321727

• 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.2425261732333435363130
• 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.192117

In 2024, Medicare Part D drug plans paid for 56,047 GLP-1 claims from prescribers in South Dakota, $64.4 million in total drug cost.63

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.67 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 South 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 B12.6869 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 South Dakota, as of November 6, 2026.64