Texas Medicaid and GLP-1s

What changed, and what the document says

1. A new authorization, with a start date

   Conditions apply

   Texas dates the requirement to the day and names who it applies to, including managed care.

   “Beginning November 24, 2025, Texas Medicaid and managed care organizations (MCOs) will require providers to get clinical prior authorization for the Wegovy MASH indication for clients who are enrolled in Medicaid fee-for-service.”

   Texas Medicaid & Healthcare Partnership (TMHP) — Last updated on 11/21/2025

2. It went through the review board

   Context

   The criteria were approved by the state's drug utilization review board before publication.

   “The Texas Drug Utilization Review (DUR) Board has reviewed and approved the clinical criteria for the Wegovy MASH indication.”

   Texas Medicaid & Healthcare Partnership (TMHP) — Last updated on 11/21/2025

3. The Zepbound guide changed the same day

   Context

   A second notice, same date, revising the tirzepatide criteria. The typo in the drug's name is the state's own.

   “The Vendor Drug Program (VDP) has updated the Zepbound (tirzapetide) clinical criteria guide.”

   Texas Medicaid & Healthcare Partnership (TMHP), Vendor Drug Program — Last updated on 11/21/2025

4. A two-year look-back on two diagnoses

   Conditions apply

   The change is technical and it matters: how far back a thyroid-cancer or endocrine-neoplasia history disqualifies you.

   “changed the look-back period for the following diagnoses to 730 days”

   Texas Medicaid & Healthcare Partnership (TMHP), Vendor Drug Program — Last updated on 11/21/2025

5. Two new product codes

   Context

   The higher tirzepatide strengths were added to the table of drugs needing authorization.

   “56686 for Zepbound 12.5 mg/0.5 ml vial”

   Texas Medicaid & Healthcare Partnership (TMHP), Vendor Drug Program — Last updated on 11/21/2025

6. Both notices carry the same stamp

   Context

   The date on these is a last-updated stamp, not an effective date — the effective dates are stated separately in the text.

   “Last updated on 11/21/2025”

   Texas Medicaid & Healthcare Partnership (TMHP) — Last updated on 11/21/2025

Which of these companies serve Texas?

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.

28 of those lists name Texas: Red Mountain Weight Loss, Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Green Cap Health, Wisp, WePeptideRx, Ways2Well, TeleClinic, Tyde Wellness, TOM Weight Loss, Willow, The Virtual NP, VevaRx, Trimi, Enhance MD, HumeCare+, Rx.com, Mojoon, Peak Wellness, Sprout Health, Allara Health, MEDvidi, PCOS Sisters, Mixx Health & Wellness, 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.