GLP-1 coverage, state by state

Pennsylvania Medical Assistance stopped paying for GLP-1s for weight loss on January 1, 2026, kept them for every other approved use, and dropped Saxenda for all of them.

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Medi-Cal Rx removed Wegovy, Zepbound and Saxenda from its drug list on January 1, 2026, and pharmacy claims for them now reject outright — with two carve-outs worth knowing.

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New Hampshire Medicaid dropped GLP-1s prescribed solely for weight loss on January 1, 2026 — a change documented by its managed-care plans rather than on a state website we could verify.

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North Carolina is the one state that ended Medicaid coverage of GLP-1s for obesity and then brought it back ten weeks later — and the version that returned has a step-therapy rule the old one didn't.

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South Carolina Medicaid's GLP-1 weight-management benefit lasted about fourteen months and ended on January 1, 2026 — recorded in a provider-manual change log rather than announced in a bulletin.

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Michigan didn't cut GLP-1s for obesity — it rewrote the criteria so that coverage now turns on being classified as morbidly obese, failing other drugs first, and heading off bariatric surgery.

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Delaware's benefits committee kept GLP-1 weight-loss coverage for state employees and attached a $200 copay per 30-day supply, after a cheaper $132 version failed on a recorded roll call.

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Colorado's employee health plans began covering GLP-1s for weight loss on May 1, 2026 — Zepbound only on the larger one — while the state's Medicaid drug list says in a footnote that a weight-loss request will not be approved.

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Ohio's Board of Pharmacy published dated end-points for compounding semaglutide and tirzepatide, banned the salt forms outright, and said retatrutide and cagrilintide cannot be compounded at all.

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Wisconsin's Group Insurance Board voted GLP-1 weight-loss coverage onto the state health plan from January 1, 2027, and the $200 copay attached to it came out of a rebate contract rather than a budget guess.

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New Jersey kept GLP-1s on the State Health Benefits Program and built a $45-or-$125 copay around whether the member is enrolled in a lifestyle management program.

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Washington's Medicaid program refuses Wegovy and Zepbound for weight loss in writing, then publishes the exact diagnoses, thresholds and test scores that will get either one approved anyway.

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Connecticut's state employee plan pays for GLP-1s only when a single contracted vendor writes the prescription, charges $12.50 a month to take part, and has been doing it since July 2023.

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Virginia Medicaid covers GLP-1s for weight loss and publishes the whole ladder on one form: a BMI floor well above the FDA's, a failed non-GLP-1 drug first, six-month approvals, and a stop point at BMI 25.

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Florida Medicaid's GLP-1 prior-authorization criteria require a type 2 diabetes diagnosis, an A1c of 6.5 or higher and a failed metformin trial — and the words obesity and weight appear nowhere in the state's 78-page drug list.

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MO HealthNet reversed a long-standing exclusion and now covers Zepbound and the orforglipron tablet for obesity, with Wegovy non-preferred and every approval running four weeks at a time through dose escalation.

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Georgia's state employee plan will not pay for an anti-obesity medication unless a designated lifestyle-management vendor writes the prescription, and Georgia Medicaid's drug list carries just two anti-obesity products, both capped at ages 12 to 17.

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Tennessee put its GLP-1 obesity drugs onto the preferred drug list from January 1, 2026, made Wegovy and Zepbound preferred, cut the first authorization to three months, and put a pharmacy edit in place that allows one GLP-1 at a time.

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A budget line ends Rhode Island Medicaid coverage of Foundayo, Saxenda, Wegovy and Zepbound for weight loss on October 1, 2026, and the state told providers in a memo that names all four drugs.

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Nevada Medicaid's drug manual refuses GLP-1s for weight loss without a diabetes indication, then opens two narrow doors: Wegovy for cardiovascular risk with a cardiologist's involvement, and Zepbound for sleep apnea — both closed to anyone who has diabetes.

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Utah Medicaid's drug list says GLP-1s are covered for type 2 diabetes only, while its own prior-authorization form treats weight-loss coverage as a legislative pilot that may not continue past June 30, 2026 and asks prescribers to sign that they know it.

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Vermont's drug list opens with a flat exclusion of weight-loss drugs and later carries Wegovy under a cardiometabolic label and Zepbound under a sleep-apnea rule, and the state's own review board counted how few people that reaches.

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Louisiana Medicaid wants a signed patient treatment agreement before either Wegovy or Zepbound is authorized, sets the Wegovy floor at age 45, and asks for a bariatric-surgery evaluation from anyone whose BMI is 35 or over.

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Mississippi Medicaid covers four anti-obesity medications for the obesity diagnosis itself, opens Saxenda and Wegovy to twelve-year-olds, approves for twelve months at a time, and measures renewal partly by whether nine claims were filled.

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Iowa puts Wegovy and Zepbound in the preferred column of its drug list and hangs footnote 12 on both of them, which says in six words that the weight-loss indication is not covered — and then opens three narrow doors that have nothing to do with weight.

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Two separate West Virginia benefits were read for this page and they reach the same answer by different routes: the Bureau for Medical Services calls weight-loss agents a benefit exclusion in its own criteria, and the public employees' plan lists anorexiants among the drugs it does not cover while offering an online weight-loss program at no cost.

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Kansas is the rarity in this set: a Medicaid program with written anti-obesity criteria that treat obesity as the qualifying diagnosis, a BMI threshold as low as 27 with one comorbidity, coverage down to age 12, and a list of seven older agents that are covered outright with no authorization at all.

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North Dakota's drug list is the most explicitly sequenced in this tier: before tirzepatide is authorized for sleep apnea you must have spent six months on semaglutide inside a weight management program, and before Wegovy is authorized you must have tolerated a full dose escalation of Ozempic first.

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Oregon publishes a drug-by-drug table of the indications its evidence supports, with a note on top of it stating that drugs prescribed only for weight management are not currently covered — and it keeps a case-by-case opening for members under the children's benefit.

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Maine's drug list keeps a standalone class headed Weight Loss whose entire content is a statement that weight-loss drugs are not covered, and it files the two GLP-1s that survive under other headings entirely: Wegovy under cardiometabolic health, Zepbound under obstructive sleep apnea.

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Indiana writes the limit into the section headings of its criteria document — each GLP-1 chapter is titled with the phrase not covered exclusively for weight loss — while a bulletin still in its published index opens a separate, older route for children under the early screening benefit.

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Kentucky's criteria carry a rule that appears nowhere else in this tier — GLP-1 medications are limited to two brand switches per year — alongside a footnote under every GLP-1 block excluding drugs used for weight loss, and a drug list on which no weight-management GLP-1 appears at all.

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Maryland runs its GLP-1 decisions through a single two-page form covering Wegovy and Zepbound together, and one of its attestations asks the prescriber to confirm a failed six-month attempt at weight loss — a requirement that reads oddly on a benefit whose transmittal says chronic weight management is not a covered reason.

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Wyoming's clinical criteria fit on two lines per drug and still manage the strictest follow-up in this tier: a second prior authorization at six months to show five percent weight loss, and a third at twelve months requiring another sleep study to prove the apnea itself improved.

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Alaska is the state in this tier with the least written down: Wegovy, Wegovy tablets and Zepbound appear on an interim prior-authorization list as single rows carrying a class code that asks only for a covered, labeled indication, and the state's drug list does not mention any of them.

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Minnesota keeps a Weight Management Agents class on its uniform drug list with Saxenda and Wegovy in the preferred column and Zepbound in the non-preferred one — a section stamped as updated in December 2024 and carried unchanged into a list effective May 2026, while the state employee plan excludes weight-loss drugs outright.

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Montana's September 2026 drug list contains no anti-obesity category of any kind — 143,000 characters with no Wegovy, no Zepbound and no Saxenda anywhere in it — and the reason sits in the program manual's non-covered list, in four words.

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Illinois is the state in this tier where the coverage rule is a statute rather than a criteria document: an act of the General Assembly requires the State Employees Group Insurance Program to cover injectable medicines to improve glucose or weight loss for adults with prediabetes, gestational diabetes or obesity, conditioned on joining a lifestyle plan.

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Hawaii's public employee trust fund added a thirty-day limit on the first fill of every GLP-1, diabetes and weight-loss alike, naming all seven products in its own benefit guide — a change its benefits committee moved and passed unanimously after being told the only drug in the excluded-drug program was Zepbound.

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New York publishes a frequently-rejected-drugs table that names Zepbound and Wegovy, prints the claim edit and denial code a pharmacy will see, and gives the statutory reason in the same row — which makes it the most operationally specific refusal in this tier.

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Alabama added Wegovy to its preferred drug list in July 2026 and attached a footnote to the same row saying the drug is non-covered for weight reduction — and did the same to Zepbound, which is marked preferred for sleep apnea and non-covered for weight reduction without it.

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The Texas documents that can actually be verified are two November 2025 notices — one adding clinical prior authorization for Wegovy's liver-disease indication, one revising the Zepbound criteria guide by adding product codes and shortening a diagnosis look-back — and the state's own outpatient drug policy chapter names no GLP-1 at all.

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Arizona is the state that put a price on the question instead of answering it — budget staff costed adding weight-loss coverage to the state employee plan at $39 million a year, a fiscal note put the same change at Medicaid scale between $962.9 million and $2.5 billion, and a study committee finished three hearings by recommending that obesity be called a chronic disease.

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Arkansas built a tirzepatide benefit with the weight indication cut out of it: Zepbound is authorized for obstructive sleep apnea alone, behind a sleep study, a sleep specialist, a six-month weight management program, and six months of nightly CPAP that failed to bring the apnea index below fifteen.

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Idaho's Office of Group Insurance ended coverage of every weight-loss medication for state employees, retirees and school district members on November 1, 2025, put the saving in writing at $30 to $50 million a year, let affected members leave the plan over it, and pointed them at two manufacturers' own counters on the way out.

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Nebraska runs Wegovy through a prior authorization form that its drug utilization review board revises in open session — adding a liver-disease indication in January 2026 on a five-vote roll call, with a Novo Nordisk representative commenting from the floor — and it has never announced any of that in a provider bulletin.

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New Mexico publishes a two-column table that puts benzphetamine, phentermine, mazindol, phendimetrazine and orlistat under "Covered, Prior Authorization Required" and puts Saxenda, Wegovy and Zepbound in the column headed "Not Covered by New Mexico Medicaid" — a split that flattens into nonsense if you read the page without its columns.

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SoonerCare does cover Wegovy and Zepbound, but only under three named indications — cardiovascular risk, MASH and obstructive sleep apnea — and each criteria block says in its own words that obesity by itself is not enough.

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South Dakota Medicaid lists agents used for weight loss among the things it does not cover, yet covers gastric surgery for weight loss with a prior authorization — and separately bans automatic refills and says a store-and-forward consultation is not telemedicine at all.

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The locally funded Health Care Alliance excludes anti-obesity medications outright — branded or generic, and even where a clinician calls them medically necessary — and moved to generic-only prescribing on January 1, 2026, while the drug list the District publishes for its own workforce carries three diabetes GLP-1s behind a notification and nothing for weight.

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An amendment filed to a fiscal 2025 supplemental budget would have required the Group Insurance Commission to cover GLP-1s for every FDA-approved indication including obesity, barred a narrower medical-necessity test, and appropriated $27,500,000 for it — and the act that was signed on September 22, 2025 contains none of it.

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