New York Medicaid and GLP-1s

What changed, and what the document says

1. The reason, printed in the rejection table

   Not covered

   New 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

2. The edit itself

   Not covered

   The 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

3. And the category, listed separately

   Not covered

   The 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

4. A separate restriction arrived through the review board

   Conditions apply

   New 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

5. Voted unanimously

   Context

   The 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

6. Which issue this is

   Context

   The 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 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.

24 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, Peak Wellness, Sprout Health, Allara Health, MEDvidi, PCOS Sisters, formidableMD, and Hormonally Balanced. 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.