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

Since July 1, 2026, Wisconsin Medicaid covers Zepbound and Foundayo for weight loss as preferred drugs in a new weight management agents class, with prior authorization that requires a BMI of 30 or more, or 27 or more with at least two listed risk factors. Wegovy injection is covered for weight loss only for members aged 12 to 17, Wegovy tablets only to lower cardiovascular risk, and Saxenda is no longer covered.1234569

Every weight management agent, including the preferred Zepbound and Foundayo, needs prior authorization requested by the prescriber. Initial approvals last up to 183 days and renewals up to 365 days, and only one weight management agent is approved per member at a time.234510

• A BMI of 30 or more, or a BMI of 27 to under 30 with two or more of: dyslipidemia, high blood pressure, sleep apnea, type 2 diabetes, or cardiovascular disease shown by a history of heart attack, coronary revascularization, angina, stroke, intermittent claudication with an ankle-brachial index of 0.9 or less, or peripheral arterial revascularization or amputation due to atherosclerotic disease.
• The member must agree to follow a reduced-calorie diet and increase physical activity.
• Renewals need a lower BMI than at the start of treatment and adherence to the prescribed regimen; renewals are not approved if BMI is below 18.5.
• Wegovy injection for weight loss: age 12 to 17 with a BMI at or above the 95th percentile for age and gender, prescribed as labeled, with the same diet and activity agreement.
• Wegovy injection or tablets for cardiovascular risk: established cardiovascular disease (prior heart attack, prior stroke or peripheral arterial disease) and a BMI of 27 or more.
• Wegovy injection for MASH: noncirrhotic MASH with F2 to F3 fibrosis by biopsy or noninvasive tests, prescribed by a liver specialist such as a gastroenterologist or hepatologist.

Coverage for other uses the FDA has approved:

• Wegovy (injection), reduction of the risk of major adverse cardiovascular events in overweight or obese adults with established cardiovascular disease (Wegovy injection and Wegovy tablets): Covered with prior authorization5
• Wegovy (injection), noncirrhotic MASH with moderate to advanced (F2 to F3) liver fibrosis in adults: Covered with prior authorization1012
• Zepbound, moderate to severe obstructive sleep apnea in adults with obesity: Covered with prior authorization11

What changed, and when:

CMS BALANCE model: CMS's BALANCE model page names no participating states, and we found no Wisconsin Department of Health Services announcement that Wisconsin has joined.14

In 2026, the Group Health Insurance Program does not cover anti-obesity medications. The Group Insurance Board has approved coverage of these drugs for non-Medicare members from 2027 in a new pharmacy tier with a $200 copay and no prior authorization; Medicare members' Part D plan will still not cover them in 2027.15161718

Pharmacy benefit: Navitus Health Solutions (pharmacy benefits).

Marketplace (ACA) plans: Wisconsin's essential health benefits benchmark plan, a UnitedHealthcare Choice Plus small-group plan, excludes any product dispensed for appetite suppression or weight loss.20

On the preferred drug list effective Nov. 1, 2026, Mounjaro, Ozempic injection, Trulicity and Victoza are preferred GLP-1 diabetes drugs and Rybelsus is non-preferred. All drugs in the class are diagnosis restricted, and non-preferred drugs need prior authorization.78

In 2025, Wisconsin Medicaid paid for 299,339 GLP-1 prescriptions, $326.2 million before rebates: 50 per 1,000 residents, against 32 across the states and DC, 8th of 51.68 It reimbursed 9 GLP-1 products that year. Every state, ranked.

CMS hides counts under 11 in a quarter, so 2 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 2027.4344343530382333

• 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.3031322338394041423736
• 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.252723

In 2024, Medicare Part D drug plans paid for 371,741 GLP-1 claims from prescribers in Wisconsin, $460.7 million in total drug cost.69

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.73 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 Wisconsin 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 B12.7475 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 1 outsourcing facilities (503B) in Wisconsin, as of November 6, 2026; 1 show no inspection date and 0 were issued a Form 483.70