State guide

North Dakota Medicaid and GLP-1s

Published by Telehealth Graded · Updated October 2026

The takeaway

North Dakota Medicaid requires six months of semaglutide in a weight program before tirzepatide for sleep apnea, and an Ozempic escalation before Wegovy.

Reading the state documents

North Dakota does not just set criteria, it sets an order. The sleep-apnea route to tirzepatide requires six months of documented pharmacotherapy with semaglutide first, and if that is not tolerated, phentermine. The cardiovascular route to Wegovy requires escalating to 2 mg of Ozempic first. Meanwhile four older obesity drugs are covered with no prior authorization at all, on a diagnosis code alone.

document cited

sourced facts

primary source

What changed, and what the document says

Four obesity drugs, no authorization
Covered
The old oral agents are covered on a diagnosis code, with nothing else asked.
“The following drugs are covered without prior authorization by submitting a corresponding”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
And they are named
Covered
A short, specific list — no GLP-1 appears on it.
“phentermine, bupropion, naltrexone, topiramate”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
Six months of semaglutide before tirzepatide
Conditions apply
This is the requirement that makes North Dakota different. The cheaper drug has to be tried first, and for half a year.
“The member must have documentation of participation in a comprehensive weight”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
The program, spelled out
Conditions apply
Behavior, diet, activity and a drug, all four, for at least six months.
“physical activity, and pharmacotherapy for at least 6 months with semaglutide.”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
An Ozempic escalation before Wegovy
Conditions apply
The same logic on the cardiovascular side: the diabetes product has to be tolerated at full dose before the obesity-labeled one is authorized.
“If the member qualifies for Wegovy injection, a dose escalation to 2mg of Ozempic injection”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
A year on injections before tablets
Conditions apply
The oral form is treated as the last resort, not the convenient one.
“Wegovy tablets: The member must have failed a 12-month trial of semaglutide injection, as”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
Six months of CPAP first
Conditions apply
The sleep-apnea route also requires the machine to have been tried and failed, with a fresh index to prove it.
“The member must have failed a 6-month trial of continuous positive airway pressure (CPAP)”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
Cost decides which tirzepatide
Context
Where more than one product would qualify, the state names price as the tiebreaker in writing.
“If the member qualifies for tirzepatide, the most cost-effective tirzepatide product will be”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026
Diabetes disqualifies you from this route
Conditions apply
The sleep-apnea pathway is closed to people with type 2 diabetes, who are routed to the diabetes criteria instead.
“The member does not have diabetes type II”
Medical Services Division, North Dakota Department of Health and Human Services — Version 2026.6, Effective: July 31, 2026

Telehealth in North Dakota

Gala HealthPartner
CCaveat
$1,299
a month, medication only
brand Ozempic (semaglutide), cash price
Additional fees not verified.
Price details
- No separate monthly fee was found in the pages reviewed. Other charges may apply.
- Brand-name Ozempic, quoted as a cash price. Gala says insurance may reduce it and does not publish what it would reduce it to.
See Gala Health pricing (opens in a new tab)
HumeCare+Partner
CCaveat
$249Signup price
a month, medication only
compounded semaglutide, six-month plan
Additional fees not verified.
Price details
- No separate monthly fee was found in the pages reviewed. Other charges may apply.
- $179 the first month, $249 a month after; the checkout totals the six months at $1,424. The card shows the later price only once the plan is selected.
- Price shown after 40 signup steps.
See HumeCare+ pricing (opens in a new tab)

Some providers pay us a commission when you sign up through our links, at no extra cost to you.

Which of these companies serve North Dakota?

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.

18 of those lists name North Dakota: Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Wisp, WePeptideRx, Ways2Well, TeleClinic, Tyde Wellness, Trimi, HumeCare+, Rx.com, Mojoon, Peak Wellness, 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.

Sources

Source dates below are the dates printed on the documents.

Pharmacy Coverage Policy Manual — Preferred Drug List (PDL) — Medical Services Division, North Dakota Department of Health and Human Services. Version and effective date printed together on the cover: Version 2026.6, Effective: July 31, 2026.

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

These providers list North Dakota in their service area. Partners appear first. These are medication prices, not confirmed monthly totals. Other fees may apply; check each provider’s terms before choosing.

Some providers pay us a commission when you sign up through our links, at no extra cost to you.

Provider	Monthly price and terms	Go to the provider
Gala HealthCCaveat	$1,299 a month, medication only brand Ozempic (semaglutide), cash price Brand-name Ozempic, quoted as a cash price. Gala says insurance may reduce it and does not publish what it would reduce it to. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at Gala Health (opens in a new tab)Partner
HumeCare+CCaveat	$249Signup price a month, medication only compounded semaglutide, six-month plan $179 the first month, $249 a month after; the checkout totals the six months at $1,424. The card shows the later price only once the plan is selected. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply. Price shown after 40 signup steps.	View pricing at HumeCare+ (opens in a new tab)Partner
TeleClinicAVerified	$79 a month, medication only compounded semaglutide Billed monthly, same price at every vial strength, and the product page says the rate is locked for the life of the membership. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at TeleClinic (opens in a new tab)
TelePeptideAVerified	$229 a month, medication only compounded semaglutide Dissolvable tablet, month-to-month. TelePeptide states on the same page that it does not sell branded GLP-1s. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at TelePeptide (opens in a new tab)
Care Bare RxBMinor gap	$199 a month, medication only compounded tirzepatide Both compounded drugs are quoted at the same starting figure, on one line that also puts brand names on them. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at Care Bare Rx (opens in a new tab)
MEDvidiBMinor gap	No verified comparable monthly GLP-1 medication price. Charged per visit rather than every month, so it is not in the figure above: $195 for weight loss introductory consultation, $159 for weight loss follow-up consultation, $249 for introductory and follow-up consultation package. See the review for plan prices and full terms.	View pricing at MEDvidi (opens in a new tab)
Peak WellnessBMinor gap	$249 a month, medication only compounded semaglutide $179 covers the first month only, and the page says so on the same line. Prepaying drops it: $597 once for three months, which is $199 a month, or $990 once for six, which is $165 — but a prepaid plan is not refundable. The price is the same at every dose. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at Peak Wellness (opens in a new tab)
Rx.comBMinor gap	$175 a month, medication only compounded semaglutide One month, all-in: the visit, the medication at any dose, supplies and cold shipping. The $146 headline is the six-month plan, paid as $875 in one payment. Additional fees not verified. Price details No separate monthly fee was found in the pages reviewed. Other charges may apply.	View pricing at Rx.com (opens in a new tab)

Our grading method and how we verify a price explain what those letters mean and where these figures came from.

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What changed, and what the document says

Four obesity drugs, no authorization

And they are named

Six months of semaglutide before tirzepatide

The program, spelled out

An Ozempic escalation before Wegovy

A year on injections before tablets

Six months of CPAP first

Cost decides which tirzepatide

Diabetes disqualifies you from this route

Telehealth in North Dakota

Which of these companies serve North Dakota?

Sources

If you're paying cash instead