Utah Medicaid does not cover Wegovy or Zepbound for weight loss

Utah Medicaid stopped covering GLP-1 drugs for weight loss on June 30, 2026, when a one-year fee-for-service pilot that had covered Wegovy, Saxenda and Zepbound ended; its preferred drug list now covers GLP-1s only for type 2 diabetes. It still covers Wegovy and Zepbound with prior authorization for other approved uses: lowering the risk of major cardiovascular events, MASH and moderate to severe obstructive sleep apnea.123514

One Utah Medicaid prior authorization form covers the GLP-1 uses that remain covered outside diabetes. Approvals for weight loss alone were limited to the pilot and ran no later than June 30, 2026.11121314

• All requests: the patient follows an exercise program and a calorie-restricted diet, has no personal or family history of medullary thyroid carcinoma or MEN 2, is not pregnant, and will not take another GLP-1, GIP or DPP-4 drug at the same time.
• Wegovy (injection or tablet) for major cardiovascular events: age 18 or older, a BMI of 27 or more, a past heart attack, coronary procedure, stroke or symptomatic peripheral arterial disease, and current secondary-prevention therapy; up to 6 months at first, then up to 12 months.
• Zepbound for obstructive sleep apnea: age 18 or older, a BMI of 30 or more, moderate to severe sleep apnea with an apnea-hypopnea index of 15 or more on a sleep study, prescribed by or with a sleep specialist, and at least 70% adherence to positive airway pressure; up to 12 months at a time.
• Wegovy injection for MASH: age 18 or older, MASH with F2 to F3 fibrosis confirmed by a FIB-4 score and a biopsy or a listed imaging or blood test, prescribed by or with a liver specialist, and no decompensated cirrhosis or other liver disease; up to 6 months at first, then up to 12 months.
• Renewals: at least 5% weight loss kept after 20 weeks for the cardiovascular use, at least a 20% drop in the apnea-hypopnea index for sleep apnea, and a maintained dose with documented clinical benefit for MASH.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in adults with a BMI of 27 or more and established cardiovascular disease (injection or tablet): Covered with prior authorization212
• Wegovy (injection), MASH with F2 to F3 liver fibrosis (injection only): Covered with prior authorization21315
• Zepbound, moderate to severe obstructive sleep apnea in adults with a BMI of 30 or more: Covered with prior authorization211

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no Utah Medicaid announcement that Utah has joined.16

PEHP covers GLP-1 drugs for diabetes but not for weight loss under its health benefits. A 2026 legislative resolution directed PEHP to add a limited GLP-1 option to its bariatric surgery pilot, with 50% cost sharing and a $300 monthly cap, but PEHP's own weight management page still says weight-loss GLP-1s are not covered.17181920

Pharmacy benefit: Express Scripts (pharmacy benefit).

Marketplace (ACA) plans: Utah's essential health benefits benchmark plan for 2025 to 2027, the PEHP Utah Basic Plus state employee plan, excludes medications for weight loss.2627

On the fee-for-service preferred drug list effective Nov. 1, 2026, Mounjaro, Ozempic injection, Trulicity and Victoza are preferred, and Rybelsus is non-preferred and needs a medication coverage exception. GLP-1s are covered only for type 2 diabetes, and only one GLP-1 a month may be covered.5678910

In 2025, Utah Medicaid paid for 27,416 GLP-1 prescriptions, $28.3 million before rebates: 8 per 1,000 residents, against 32 across the states and DC, 44th of 51.76 It reimbursed 7 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 69 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 2027.5152424338463141

• 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.3839403146474849504544
• 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.333531

In 2024, Medicare Part D drug plans paid for 129,608 GLP-1 claims from prescribers in Utah, $159.0 million in total drug cost.77

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.81 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 Utah 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 B12.8283 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 Utah, as of November 6, 2026.78

FDA warning letters naming a GLP-1, sent to a company in Utah:79