Texas Medicaid covers Foundayo for weight loss, but not Wegovy or Zepbound

Marketplace (ACA) plans: Texas's essential health benefits benchmark plan, a Blue Cross and Blue Shield of Texas small-group PPO, excludes drugs prescribed for obesity or weight loss.24

Texas Medicaid's prior authorization criteria do not approve Wegovy (injection or tablet) or Zepbound for weight loss alone: Wegovy is approved only for cardiovascular disease with obesity or overweight, or for MASH (injection only), and Zepbound only for moderate to severe obstructive sleep apnea with obesity. Saxenda is not on the formulary. Foundayo has been on the Texas Medicaid formulary since Sept. 29, 2026, and the formulary search shows no clinical or preferred-drug-list prior authorization for it.123456

Wegovy, Zepbound and the diabetes GLP-1s each have their own HHSC clinical prior authorization criteria, which Medicaid managed care plans must also apply.567814

• Wegovy (injection or tablet), cardiovascular path: age 45 or older, a diagnosis of cardiovascular disease and a diagnosis of obesity or overweight in claims history, used with a reduced-calorie diet and more physical activity; approved for 365 days.
• Wegovy injection, MASH path: age 18 or older, a diagnosis of non-cirrhotic MASH, moderate to advanced liver fibrosis (F2 to F3) confirmed by biopsy or a listed non-invasive test in the last 180 days; the tablet is denied on this path.
• Wegovy: no history of medullary thyroid carcinoma or MEN 2, no other GLP-1 at the same time, at most 4 pens per 28 days or 1 tablet per day.
• Zepbound: age 18 or older, a diagnosis of moderate to severe obstructive sleep apnea, an apnea-hypopnea index of at least 15 events per hour on a sleep study, a diagnosis of obesity, used with a reduced-calorie diet and more physical activity, at most 15 mg weekly; initial approval 180 days, renewal needs at least 5% weight loss kept from baseline.
• Diabetes GLP-1s (Ozempic, Mounjaro, Rybelsus, Trulicity, Victoza): a type 2 diabetes diagnosis in the last 365 days, an HbA1c test in the last 180 days, no end-stage renal disease, MTC or MEN 2, no other GLP-1 at the same time; approved for 365 days.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults with cardiovascular disease and obesity or overweight: Covered with prior authorization515
• Wegovy (injection), MASH with moderate to advanced liver fibrosis (injection only): Covered with prior authorization516
• Wegovy tablets, cardiovascular risk reduction in adults 45 or older with cardiovascular disease and obesity or overweight: Covered with prior authorization15
• Zepbound, moderate to severe obstructive sleep apnea with obesity: Covered with prior authorization26

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no HHSC announcement that Texas has joined.18

On the preferred drug list, the Ozempic pens, Trulicity and Victoza are preferred; Mounjaro, Rybelsus and the Ozempic tablets are non-preferred. All of them also need clinical prior authorization that requires a type 2 diabetes diagnosis. In October 2026 the Drug Utilization Review Board recommended moving Mounjaro to preferred, which is pending HHSC's final decision for the January preferred drug list.9101112137

In 2025, Texas Medicaid paid for 170,583 GLP-1 prescriptions, $178.1 million before rebates: 5 per 1,000 residents, against 32 across the states and DC, 48th of 51.72 It reimbursed 7 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 77 rows count as zero here and the totals are a floor.

The HealthSelect Prescription Drug Program for the plan year that began Sept. 1, 2026, excludes drugs prescribed solely for obesity, naming Zepbound and Saxenda as examples. Wegovy may be covered with prior authorization only for adults with cardiovascular disease and obesity or overweight, or for MASH. The MASH use was added for this plan year; the previous year's document listed only the cardiovascular use.192021

Pharmacy benefit: Blue Cross and Blue Shield of Texas (medical); Express Scripts (Prescription Drug Program).

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 1,811,427 GLP-1 claims from prescribers in Texas, $2.39 billion 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 Texas 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 Texas’s board of pharmacy or attorney general on their own sites.25

The FDA’s register lists 17 outsourcing facilities (503B) in Texas, as of November 6, 2026; 11 show no inspection date and 6 were issued a Form 483.74

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