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

TennCare has covered drugs for obesity management since Aug. 1, 2025. Wegovy injection and the Zepbound single-dose pen are preferred drugs with prior authorization and quantity limits, and Saxenda is non-preferred, so it also needs a trial of two preferred drugs. Wegovy tablets and Foundayo are not on the preferred drug list: for weight management they are covered only for members aged 18 to 20 with prior authorization, and are not covered for members 21 and older.12345

Requests for GLP-1 drugs for weight management go to Optum Rx on TennCare's Weight Management Agents prior authorization form. Initial approvals last 1 year, and renewals need documented weight loss.34589

• Wegovy injection (age 12 or older) and Zepbound single-dose pen (age 18 or older), both preferred: treatment is for obesity management, with medical records showing, for adults, a BMI of 30 or more, or a BMI of 27 or more with a weight-related condition (for example high blood pressure, dyslipidemia, diabetes, coronary heart disease, MASH/NASH or obstructive sleep apnea); for Wegovy patients under 18, a BMI at or above the 95th percentile for age and sex.
• The prescriber attests that the patient is taking part in nutritional and lifestyle changes, such as diet changes, more physical activity, behavioral therapy or a weight management program.
• No other obesity drug and no other GLP-1 at the same time, no DPP-4 inhibitor, and no personal or family history of medullary thyroid carcinoma or MEN2.
• Renewal: continued lifestyle changes and medical records showing a weight loss of at least 5% from baseline; members who do not meet renewal criteria may be approved for one more month to taper off.
• Non-preferred Saxenda or generic liraglutide: the same criteria plus a trial and failure, contraindication or intolerance of two preferred drugs.
• Wegovy tablets and Foundayo for weight management: ages 18 to 20 only, a trial of 2 preferred GLP-1 weight management drugs, and a clinically valid reason, shown in medical records, why the patient cannot use an injectable GLP-1.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in patients with a BMI of 27 or more and a prior heart attack, stroke or symptomatic peripheral arterial disease (Wegovy tablets only with a reason the injection cannot be used): Covered with prior authorization1011
• Wegovy (injection), NASH/MASH with F2 or F3 liver fibrosis, prescribed by or with a gastroenterologist or hepatologist: Covered with prior authorization10
• Zepbound, obstructive sleep apnea with a BMI of 30 or more, 15 or more breathing events per hour on a sleep study, and a 3-month CPAP or BiPAP trial unless contraindicated: Covered with prior authorization10

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no TennCare announcement that Tennessee has joined.17

The State of Tennessee group health plan covers certain preferred anti-obesity drugs chosen by its pharmacy benefits manager, CVS Caremark, with prior authorization. Members in all plans pay 25% coinsurance for weight-loss drugs, limited to a 30-day supply per fill. On the Caremark formulary for the State of Tennessee effective Oct. 1, 2026, Wegovy, Zepbound and Foundayo are preferred brand drugs that need prior authorization.18192021

Pharmacy benefit: CVS Caremark (pharmacy benefits); Benefits Administration, Tennessee Department of Finance and Administration.

Marketplace (ACA) plans: Tennessee's essential health benefits benchmark plan, a BlueCross BlueShield of Tennessee small-group plan, excludes anorectics, meaning any drug used for weight loss and appetite suppression.2425

On the TennCare preferred drug list effective Nov. 2, 2026, Mounjaro and Ozempic injections are preferred GLP-1 agonists, and Rybelsus, Trulicity, Victoza and Ozempic tablets are non-preferred. Every GLP-1 agonist needs prior authorization; for type 2 diabetes the prescriber documents a qualifying lab value, such as an HbA1c of 6.5% or more.67

In 2025, TennCare paid for 134,111 GLP-1 prescriptions, $143.1 million before rebates: 18 per 1,000 residents, against 32 across the states and DC, 36th of 51.72 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 2027.4748383934422737

• 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.3435362742434445464140
• 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.293127

In 2024, Medicare Part D drug plans paid for 577,179 GLP-1 claims from prescribers in Tennessee, $722.4 million in total drug cost.73

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.77 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 Tennessee 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 B12.7879 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 Tennessee’s board of pharmacy or attorney general on their own sites.

The FDA’s register lists 4 outsourcing facilities (503B) in Tennessee, as of November 6, 2026; 3 show no inspection date and 1 were issued a Form 483.74

FDA warning letters naming a GLP-1, sent to a company in Tennessee:75