Texas Medicaid and GLP-1s
Texas publishes its GLP-1 decisions as short notices rather than criteria documents, and two of them landed on the same day in November 2025. One added prior authorization for Wegovy's liver-disease indication after a review-board vote. The other updated the Zepbound guide, adding two product codes and changing how far back a disqualifying diagnosis counts. The provider manual chapter that governs outpatient drugs mentions none of these drugs.
What changed, and what the document says
A new authorization, with a start date
Conditions applyTexas 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
It went through the review board
ContextThe 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
The Zepbound guide changed the same day
ContextA 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
A two-year look-back on two diagnoses
Conditions applyThe 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
Two new product codes
ContextThe 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
Both notices carry the same stamp
ContextThe 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 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.
22 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 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.
- Wegovy Clinical Prior Authorization for New Metabolic Dysfunction-Associated Steatohepatitis (MASH) Indication — Texas Medicaid & Healthcare Partnership (TMHP). Last-updated stamp printed under the headline; the notice separately states an implementation date of November 24, 2025: Last updated on 11/21/2025.
- Zepbound Clinical Prior Authorization Criteria Guide Updates — Texas Medicaid & Healthcare Partnership (TMHP), Vendor Drug Program. Last-updated stamp printed under the headline: Last updated on 11/21/2025.
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.
Ro, Mochi Health and PlushCare 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 | Ro | $349a month, medication onlybrand 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 $199The lowest of the 2 medication prices we captured here | Brand semaglutide at $349 and tirzepatide at $449, advertised at $199 and $299 — the manufacturer's products, priced without a prior authorization for a liver indication in the way. | See its prices at Ro (opens in a new tab)Pays us nothing |
| BMinor gap | Mochi Health | $139a month, everything billed monthly$60 compounded semaglutide + $79 a month for membershipMandatory membership fee, billed separately from medication — Mochi's own line: "Medications and diagnostic services not included in membership subscription."Medication only — does not include Mochi's separate $79/mo membership fee below (first month $39).The lowest of the 3 medication prices we captured here | Compounded semaglutide at $60 and tirzepatide at $90, with brand tirzepatide at $299, so all three tiers are visible on one roster row. | See its prices at Mochi Health (opens in a new tab)Pays us nothing |
| 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 route to the specialist documentation a liver-disease authorization needs. | See its prices at PlushCare (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.