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

Virginia Medicaid lists Wegovy, Wegovy HD, Zepbound, Saxenda and Foundayo as non-preferred drugs in its closed Weight Management Agents class, so each needs a service authorization. The weight-loss criteria require a BMI over 40, or over 37 with dyslipidemia, high blood pressure or type 2 diabetes, a failed trial of a non-GLP-1 weight-loss drug, nutritional counseling and a physical activity program. The preferred drug list applies to fee-for-service members and to non-dual-eligible members in Cardinal Care managed care.12341112

Virginia Medicaid uses one Weight-Loss Management service authorization form for all weight-loss drugs; the current version took effect Oct. 20, 2026. GLP-1 approvals last 6 months at a time.1345

• GLP-1s for weight loss: BMI over 40 with no listed risk factor, or BMI over 37 with dyslipidemia, high blood pressure or type 2 diabetes. Minimum ages: 12 for Wegovy and Saxenda injections, 18 for Wegovy HD, Wegovy tablets, Zepbound and Foundayo.
• A failed trial of one non-GLP-1 weight-loss drug (or intolerance to all of them), and no other GLP-1 at the same time.
• A failed trial of the GLP-1 the preferred drug list names as the selected product: injectable brand Wegovy, not the high-dose form. A GLP-1 trial counts as failed after 6 months without a 5% loss of body weight.
• Zepbound single-dose pens need a failed trial of Zepbound KwikPen first.
• Wegovy tablets and Foundayo also need a medical contraindication to an injectable product or failed trials of two injectable products.
• Participation in nutritional counseling and a physical activity program, a commitment to continue the plan, and a prescriber attestation that the member's obesity is disabling and life threatening.
• A medical status and weight-loss plan, and height and weight measured, within the last 60 days.
• Renewal: another 6 months if the member has lost at least 5% of body weight since the last authorization; no renewals once the BMI is under 25.

Coverage for other uses the FDA has approved:

• Wegovy (injection), cardiovascular risk reduction in adults 45 or older with a BMI of 27 or more, a past heart attack, stroke or peripheral artery disease, and no diabetes; prescribed by a cardiologist or vascular specialist: Covered with prior authorization6
• Zepbound, moderate to severe obstructive sleep apnea in adults with a BMI of 30 or more, after CPAP; Zepbound KwikPen must be tried before the single-dose pen: Covered with prior authorization7
• Wegovy (injection), MASH with F2 or F3 liver fibrosis in adults, prescribed by or with a liver specialist: Covered with prior authorization8

What changed, and when:

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

The state employee health plan covers GLP-1s for weight loss with prior authorization. Since July 1, 2026, a new request needs a BMI of 35 or more; members already on a GLP-1 under an active authorization who stay compliant are renewed under the previous rule (BMI of 30 or more, or 27 or more with a qualifying condition).181920

Pharmacy benefit: Anthem Pharmacy delivered by CarelonRx (prescription drugs); Anthem (medical).

Marketplace (ACA) plans: Virginia's essential health benefits benchmark plan for 2025 to 2027, based on an Anthem Blue Cross and Blue Shield PPO, excludes any drug mainly used for weight loss.23

In the closed incretin mimetics class of the preferred drug list effective Oct. 1, 2026, Trulicity and Victoza are preferred and need a type 2 diabetes diagnosis. Ozempic, Mounjaro and Rybelsus are non-preferred: a service authorization needs a type 2 diabetes diagnosis (an A1c of 6.5 or more for first starts) and trials of two preferred drugs.910

In 2025, Cardinal Care paid for 223,332 GLP-1 prescriptions, $228.0 million before rebates: 25 per 1,000 residents, against 32 across the states and DC, 24th of 51.71 It reimbursed 9 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 75 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 2027.4647373833412636

• 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.3334352641424344454039
• 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.283026

In 2024, Medicare Part D drug plans paid for 443,694 GLP-1 claims from prescribers in Virginia, $569.8 million in total drug cost.72

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.76 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 Virginia 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 B12.7778 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 Virginia’s board of pharmacy or attorney general on their own sites.24

The FDA’s register lists 2 outsourcing facilities (503B) in Virginia, as of November 6, 2026; 1 show no inspection date and 1 were issued a Form 483.73

FDA warning letters naming a GLP-1, sent to a company in Virginia:74