MaineCare and GLP-1s

What changed, and what the document says

1. A class whose only content is a refusal

   Not covered

   The Weight Loss heading exists on the list. What sits under it is the reason nothing else does.

   “Weight loss drugs are not covered as permitted by Federal Medicaid regulations and Maine Medicaid (MaineCare) Policy.”

   MaineCare, Maine Department of Health and Human Services — PDL Effective July 1, 2026

2. Three products named as dropped

   Not covered

   The same cell names what used to be there, which dates the change in the list's own terms rather than ours.

   “No longer covered:”

   MaineCare, Maine Department of Health and Human Services — PDL Effective July 1, 2026

3. And those three are

   Not covered

   Two older appetite suppressants and a fat absorption blocker — the pre-GLP-1 generation.

   “Phentermine,Xenical, Didrex, and”

   MaineCare, Maine Department of Health and Human Services — PDL Effective July 1, 2026

4. Wegovy is filed under cardiometabolic health

   Conditions apply

   The criteria travel with the heading: a BMI floor of 27 and an explicit instruction that weight loss alone is not the indication.

   “Wegovy: Patient has BMI > 27 kg/m2, and is not being used for weight loss only”

   MaineCare, Maine Department of Health and Human Services — PDL Effective July 1, 2026

5. Zepbound is filed under sleep apnea

   Conditions apply

   Maine's sleep-apnea route specifies a three-year window on the sleep study and a defined CPAP failure. The document prints the BMI unit as mg/kg2, a source typo preserved in the quotation below.

   “Zepbound for adults with a BMI ≥ 30 mg/kg2 and diagnosis of moderate to severe OSA, confirmed by sleep study within the last 3 years documenting AHI ≥ 15, AND in which CPAP is”

   MaineCare, Maine Department of Health and Human Services — PDL Effective July 1, 2026

6. The form asks the question directly

   Not covered

   The prior-authorization form puts the policy in the question itself, so the prescriber is answering a coverage rule rather than a clinical one.

   “MaineCare policy does not allow coverage for weight loss products”

   State of Maine Department of Health & Human Services — Semaglutide-MACE.02, Form #23976, C:03.26

Which of these companies serve Maine?

Of the 387 companies we grade, 34 publish a list of the states they are licensed in. We checked 251 more and found no such list on any page we read; 102 we have not checked either way.

22 of those lists name Maine: Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Wisp, WePeptideRx, Ways2Well, TeleClinic, Tyde Wellness, Willow, VevaRx, Trimi, Enhance MD, HumeCare+, Rx.com, Mojoon, Peak Wellness, Sprout Health, Allara Health, MEDvidi, and Mixx Health & Wellness. That is a licensure claim each company makes about itself, not something we checked with a state board.

A published list is a starting point, not a guarantee. If availability decides your choice, ask before you pay and get the answer in writing.

Coverage decides what you pay before cash does. See how state Medicaid programs cover GLP-1s and what a prior-authorization denial turns on.