New York Medicaid and GLP-1s
Most states tell you what they will not cover. New York tells you what the pharmacy screen will say when it happens. Its March 2026 Medicaid Update carries a table of frequently rejected drugs with Zepbound and Wegovy in it, the edit number, the denial code, the manufacturer, and a one-line reason citing the federal statute. The same program spent the previous autumn adding a different GLP-1 restriction through its review board.
What changed, and what the document says
The reason, printed in the rejection table
Not coveredNew York puts the statutory basis in the same row as the drug and the denial code, so the pharmacy sees the reason and the code together.
“Drugs indicated for weight loss are not covered pursuant to SSA §1927(d)(2)”
New York State Department of Health — March 2026 Volume 42 – Number 4
The edit itself
Not coveredThe exclusion is implemented as a claim edit on the drug code, not as a criteria review.
“NDC exclude from State Plan.”
New York State Department of Health — March 2026 Volume 42 – Number 4
And the category, listed separately
Not coveredThe same update repeats the exclusion as a general category, alongside sexual dysfunction and cosmetic drugs.
“Drugs used for the treatment of anorexia, weight loss or weight gain pursuant to SSA §1927(d)(2)”
New York State Department of Health — March 2026 Volume 42 – Number 4
A separate restriction arrived through the review board
Conditions applyNew York's live GLP-1 activity is about combinations, not obesity: taking a DPP-4 inhibitor and a GLP-1 together now needs authorization.
“Prior authorization will be required for patients utilizing a Dipeptidyl Peptidase-4 (DPP-4) Inhibitor and Glucagon-like Peptide-1 (GLP-1) Receptor Agonist concurrently.”
New York State Department of Health, Medicaid Drug Utilization Review Board — Friday, October 3, 2025
Voted unanimously
ContextThe board recorded sixteen in favor and none against, and the commissioner adopted it as recommended.
“Vote: In favor 16”
New York State Department of Health, Medicaid Drug Utilization Review Board — Friday, October 3, 2025
Which issue this is
ContextThe rejection table is in a numbered monthly update, so it can be checked against later issues as the list changes.
“March 2026 Volume 42 – Number 4”
New York State Department of Health — March 2026 Volume 42 – Number 4
Which of these companies serve New York?
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 New York: Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Wisp, WePeptideRx, TeleClinic, Tyde Wellness, Willow, The Virtual NP, 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.
- New York State Medicaid Update — March 2026, Volume 42, Number 4 — New York State Department of Health. Issue line printed at the head of the update: March 2026 Volume 42 – Number 4.
- New York State Medicaid Drug Utilization Review Board — Meeting Summary — New York State Department of Health, Medicaid Drug Utilization Review Board. Meeting date, stated in the summary's opening sentence: Friday, October 3, 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. 1 of these 3 bills a fee every month on top of the medication, so the figure is the two added together. The other 2 say in the cell what we could capture and what we could not. Every number was read on the seller's own page; the adding up is ours.
NovoCare Pharmacy, Zealthy and Lemonaid Health pay us nothing — none of the 3 below does. The buttons run through our own redirect so we can count the click, and counting is all they do.
| Grade | Provider | What a month actually costs | The one thing that matters here | Go to the provider |
|---|---|---|---|---|
| BMinor gap | NovoCare Pharmacy | $149a month, medication onlybrand Wegovy tablets 1.5 mgMedication 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.Self-pay. One month is one bottle of 30 tablets.The lowest of the 9 medication prices we captured here | Wegovy tablets at $149, $199 and $299 direct — the manufacturer's own cash channel for one of the two drugs New York's table rejects by code. | See its prices at NovoCare Pharmacy (opens in a new tab)Pays us nothing |
| CCaveat | Zealthy | $297a 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.Advertised at $151The lowest of the 2 medication prices we captured here | Advertises $151 and bills $297 for compounded semaglutide, and advertises $216 against $449 for tirzepatide, so both numbers matter before you treat it as the cheap option. | See its prices at Zealthy (opens in a new tab)Pays us nothing |
| CCaveat | Lemonaid Health | $248a month, everything billed monthly$199 compounded semaglutide microdoses + $49 a month for weight loss membershipCharged on top of the medication, which the same line says is billed separately.The lowest of the 7 medication prices we captured here | A $49 membership plus $299 for compounded semaglutide, or $199 for microdoses — three charges to total up where the state benefit contributes nothing. | See its prices at Lemonaid Health (opens in a new tab)Pays us nothing |
Our grading method and how we verify a price explain what those letters mean and where these figures came from.