Apple Health does not cover Wegovy or Zepbound for weight loss

Apple Health does not cover GLP-1 drugs for weight loss: state rules exclude any drug prescribed for weight loss, and HCA's policies say Wegovy (injection and tablets) and Zepbound are not covered for weight loss. The Apple Health Preferred Drug List marks Foundayo and Saxenda as not covered weight-loss products. Wegovy is covered with prior authorization only to lower cardiovascular risk or for MASH, and Zepbound only for moderate to severe obstructive sleep apnea.12345

Apple Health fee-for-service and managed care plans use the same preferred drug list and HCA policies. Wegovy and Zepbound are preferred in their class but are approved only for the non-weight-loss uses in HCA's policies.67911

• Wegovy (injection or tablet), cardiovascular path: age 18 or older, a BMI of 27 or more, no diabetes and an HbA1c not above 6.5%, established cardiovascular disease (prior stroke, prior heart attack, or symptomatic carotid, coronary or peripheral arterial disease), a treatment plan that includes antiplatelet, blood pressure or lipid-lowering therapy, and no other GLP-1 or DPP-4 inhibitor at the same time; first approval 6 months, renewal 12 months.
• Wegovy injection, MASH path: age 18 or older, no diabetes and an HbA1c not above 6.5%, moderate to severe MASH (F2 or F3) confirmed by biopsy or a listed noninvasive test, and at least one cardiovascular risk factor; first approval 6 months, renewal 12 months without cirrhosis.
• Zepbound, obstructive sleep apnea: age 18 or older, no diabetes and an HbA1c not above 6.5%, provider attestation of moderate to severe sleep apnea (AHI or RDI of 15 or more), a documented discussion of PAP therapy, engagement in diet, exercise and behavior changes, a BMI above 30, and no other GLP-1; first approval 6 months, renewal 12 months with a documented positive response.
• Diabetes GLP-1s: a type 2 diabetes diagnosis or an HbA1c of 6.5 or more in the last 12 months, the product's age limit (18 or older for semaglutide, 10 or older for dulaglutide, exenatide, liraglutide and tirzepatide), and no other GLP-1 or DPP-4 inhibitor; non-preferred drugs also need a failed 90-day trial of metformin and of two preferred GLP-1s.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight, without diabetes: Covered with prior authorization6
• Wegovy tablets, reduction of the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight, without diabetes: Covered with prior authorization68
• Wegovy (injection), noncirrhotic MASH with F2 or F3 liver fibrosis in adults, without diabetes (injection only): Covered with prior authorization7
• Zepbound, moderate to severe obstructive sleep apnea in adults with obesity, without diabetes: Covered with prior authorization9

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no HCA announcement that Washington has joined.14

The 2026 UMP Classic certificate of coverage for state employees (PEBB) excludes prescription drugs for obesity or weight loss, and any drugs for weight control, weight loss or obesity treatment. On the 2026 UMP Preferred Drug List, Ozempic, Mounjaro and Trulicity are limited to a type 2 diabetes diagnosis. The 2027 certificate, effective Jan. 1, 2027, keeps the same exclusion.15161718

Pharmacy benefit: Regence BlueShield (medical); ArrayRx, with Moda Health administering pharmacy benefits.

Marketplace (ACA) plans: Washington's essential health benefits benchmark plan for 2026 to 2028, the Regence Direct Gold+ small-group plan, excludes medical treatment, programs or supplies intended for weight reduction, except where federal law requires coverage or for preventive services.22

On the Apple Health Preferred Drug List for Nov. 7 to 13, 2026, Ozempic injection, Trulicity and exenatide are the preferred diabetes GLP-1s; Mounjaro, Rybelsus, Ozempic tablets, Victoza and generic liraglutide are non-preferred. All need prior authorization: a type 2 diabetes diagnosis or an HbA1c of 6.5 or more in the last 12 months, and a non-preferred drug also needs a 90-day trial of metformin and of two preferred GLP-1s.511

In 2025, Apple Health paid for 59,979 GLP-1 prescriptions, $61.0 million before rebates: 7 per 1,000 residents, against 32 across the states and DC, 45th of 51.73 It reimbursed 8 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 2027.4849394035432838

• 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.3536372843444546474241
• 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.303228

In 2024, Medicare Part D drug plans paid for 336,462 GLP-1 claims from prescribers in Washington, $426.8 million in total drug cost.74

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.78 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 Washington 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 B12.7980 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 Washington, as of November 6, 2026.75