Maryland Medicaid and GLP-1s
Maryland's whole GLP-1 policy fits on one form, and the form is more revealing than most criteria documents. It wants a dated cardiovascular event, a BMI within the last ninety days, a named specialist, and an attestation that the patient already tried to lose weight for six months and did not. The 2024 transmittal underneath it says plainly that weight management on its own is not why the drug gets paid for.
What changed, and what the document says
Chronic weight management is not a covered reason
Not coveredThe transmittal that opened Maryland's Wegovy coverage says what it is not for, in the same breath as what it is for.
“Wegovy will not be covered when the sole indication is for chronic weight management”
Maryland Medical Assistance Program, Medical Benefits Management — September 13, 2024
But the form still wants a failed weight-loss attempt
Conditions applyAn attestation on a benefit that is not for weight loss, asking the prescriber to confirm that weight loss was attempted and did not work.
“Patient has engaged in a trial of weight loss management in the past 6 months and failed to achieve weight loss.”
Maryland Medicaid, Office of Pharmacy Services — MDH - 12/2025
A BMI no older than ninety days
Conditions applyMaryland dates the measurement rather than accepting a number from the chart.
“Patient has BMI of 27kg/m2 or greater within the last 90 days”
Maryland Medicaid, Office of Pharmacy Services — MDH - 12/2025
A cardiologist on the request
Conditions applyThe cardiovascular route needs a cardiologist's involvement, which is a referral before it is a prescription.
“Prescribed by or in consultation with a cardiologist”
Maryland Medicaid, Office of Pharmacy Services — MDH - 12/2025
No stacking
Conditions applyStated twice on one form, once under each drug.
“Patient not concurrently using any other GLP-1 receptor agonists.”
Maryland Medicaid, Office of Pharmacy Services — MDH - 12/2025
A sleep study with a number attached
Conditions applyThe Zepbound half of the form sets the same threshold most states use and asks for the index itself.
“study with an apnea-hypopnea index (AHI) ≥ 15 events per hour with obesity”
Maryland Medicaid, Office of Pharmacy Services — MDH - 12/2025
Priced per invoice, not per claim
ContextAn unusual billing detail from the transmittal: Maryland reimbursed this through a procedure code priced off the invoice.
“The Medicaid FFS program will reimburse Wegovy under HCPCS code J3490”
Maryland Medical Assistance Program, Medical Benefits Management — September 13, 2024
Which of these companies serve Maryland?
Of the 242 companies we grade, 25 publish a list of the states they are licensed in. We checked 214 more and found no such list on any page we read; 3 we have not checked either way.
18 of those lists name Maryland: Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Wisp, WePeptideRx, Ways2Well, TeleClinic, Tyde Wellness, Willow, VevaRx, Trimi, Enhance MD, HumeCare+, Rx.com, Mojoon and Peak 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.
Sources
Each document below was fetched and read on the date shown beside it, which is the date printed on the document — not always the date in its web address. All of them were read in September 2026, the same session as the rest of this page.
- PT 35-25 — Coverage of Wegovy for Overweight or Obese Adults with Cardiovascular Disease — Maryland Medical Assistance Program, Medical Benefits Management. Issue date on the masthead; the subject line separately states "Effective September 15, 2024": September 13, 2024.
- Wegovy and Zepbound Prior Authorization Form — Maryland Medicaid, Office of Pharmacy Services. Revision stamp printed in the footer of both pages; the form prints no effective date: MDH - 12/2025.
Nothing on this page is medical advice, and nobody here is a clinician. Coverage rules change; check the linked document before you rely on it.
If you're paying cash instead
None of the above changes what a telehealth seller charges you. None of the 3 rows below carries both a medication price and a monthly fee we could capture, so no figure here is a sum. Each cell says what its number covers and what we could not confirm, and every number was read on the seller's own page.
1 of these 3 pays us a commission if you start there: Oak. PlushCare and Form Health pay us nothing. A commission never changes a grade.
| Grade | Provider | What a month actually costs | The one thing that matters here | Go to the provider |
|---|---|---|---|---|
| BMinor gap | PlushCare | No month-to-month medication price we could capture, so there is no monthly total to show.What they do bill every month: $19.99 a month for membership.Charged per visit rather than every month, so it is not in the figure above: $129 for visit, no insurance.The review says what else we found. | A $19.99 membership and a $129 visit without insurance — the cheapest way to get the BMI reading Maryland insists be less than ninety days old. | See its prices at PlushCare (opens in a new tab)Pays us nothing |
| CCaveat | Form Health | No month-to-month medication price we could capture, so there is no monthly total to show.What they do bill every month: $299 a month for membership.The review says what else we found. | A $299 monthly membership with clinician care included and the drug billed separately, which is the closest private equivalent to Maryland's specialist-consultation requirement. | See its prices at Form Health (opens in a new tab)Pays us nothing |
| FFail | Oak | $190a month, medication onlycompounded semaglutideMedication only. We captured no separate monthly charge on the pages we read, which is what we found rather than proof that nothing else is billed.Oak states this as a program-wide starting figure, not a price for semaglutide specifically — it does not price any single medication anywhere on its site. Its homepage answers the same cost question with a lower number. | Compounded semaglutide at $190 a month with no separate consultation charge, the simplest cash number to hold against a form with seven attestations on it. | See its prices at Oak (opens in a new tab)Pays us a commission |
Our grading method and how we verify a price explain what those letters mean and where these figures came from.