Apple Health and GLP-1s in Washington
Apple Health won't pay for Wegovy or Zepbound to lose weight, and says so in one flat sentence in each drug's policy. What makes Washington worth reading is the rest of the page: two other routes are open, both are written down with numbers attached, and both are strict.
What changed, and what the document says
Wegovy, for weight loss
Not coveredRefused outright, citing a state rule and the federal statute that makes the benefit optional.
“Semaglutide injection or tablet (Wegovy®) is not covered by Apple Health for weight loss in accordance with:”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 2/1/2026
Zepbound, for weight loss
Not coveredSame answer, same two citations, in a separate policy of its own.
“Tirzepatide (Zepbound®) is not covered by Apple Health for weight loss”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 5/1/2025
The door Wegovy still has
Conditions applyEstablished cardiovascular disease, spelled out event by event. A risk factor won't do it.
“4. Patient has established cardiovascular disease with one or more of the following: a. Prior stroke (ischemic or hemorrhagic); OR b. Prior myocardial infarction (MI); OR”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 2/1/2026
And you have to already be on treatment
Conditions applyThe prescription doesn't stand alone. Something else for the heart has to be running alongside it.
“5. Treatment plan includes the following: a. Concurrent use of either of the following for secondary prevention of adverse CV events unless medication is contraindicated or not tolerated (i, ii, or iii):”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 2/1/2026
The door Zepbound still has
Conditions applySleep apnea, measured. Fifteen events an hour, attested by the prescriber, without a machine helping.
“Provider attestation that patient has moderate to severe obstructive sleep apnea as defined as AHI or RDI ≥ 15 obstructive respiratory events per hour (apneas, hypopneas, or RERAs), without the use of a positive airway pressure device (PAP); AND”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 5/1/2025
Renewal wants proof it worked
ContextThree things count as evidence, and one of them is the weight itself.
“Documentation is submitted demonstrating a positive clinical response [e.g., weight loss, fewer AHIs per hour of sleep, or improved systolic blood pressure].”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 5/1/2025
How long an approval lasts
ContextSix months to start, on both drugs.
“If ALL criteria are met, the request will be authorized for 6 months.”
Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria — Effective Date: 2/1/2026
Which of these companies serve Washington?
Of the 101 companies we grade, 12 publish a list of the states they are licensed in. We checked 86 more and found no such list on any page we read; 3 we have not checked either way.
8 of those lists name Washington: Gala Health, Care Bare Rx, Vita Bella, TelePeptide, Levity, Wisp, WePeptideRx and Ways2Well. 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.
- Anorexiants/Anti-Obesity: GLP-1 Receptor Agonists- Wegovy® (semaglutide) — Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria. the "Effective Date" printed in the header beside medical policy no. 61.25.20.AA-4: Effective Date: 2/1/2026.
- Anorexiants/Anti-Obesity: GLP-1 Receptor Agonists – Zepbound® (tirzepatide) — Washington State Health Care Authority — Apple Health (Medicaid) drug coverage criteria. the "Effective Date" printed in the header beside medical policy no. 61.25.25.AA-1: Effective Date: 5/1/2025.
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.
Henry Meds, QuickMD and Hims 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 | Henry Meds | $179a month, medication onlycompounded liraglutideMedication 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.Daily compounded liraglutide injections, up to 90 mg every 60 days, injection kit included. This is the cheapest injectable Henry sells and the number its product-page FAQ quotes as the starting price.The lowest of the 3 medication prices we captured here | Publishes a complete month-to-month price for every plan with dose ceilings attached, which is rare. The catch is that the $179 you meet while shopping is the liraglutide floor and injectable semaglutide is $297. | See its prices at Henry Meds (opens in a new tab)Pays us nothing |
| BMinor gap | QuickMD | No month-to-month medication price we could capture, so there is no monthly total to show.Charged per visit rather than every month, so it is not in the figure above: $99 for weight loss visit.The review says what else we found. | Sells a $99 visit with no membership and says plainly that drug costs vary by pharmacy — useful if a prior authorization is what you actually need, useless as a price for the drug. | See its prices at QuickMD (opens in a new tab)Pays us nothing |
| CCaveat | Hims | $298a month, everything billed monthly$149 brand semaglutide + $149 a month for membershipThe Weight Loss Membership itself. It runs $39 the first month and renews at $149 a month, is billed separately from the medication, and Hims says medication is not available without it.This is the medication price for the Wegovy oral pill. Hims states on the same page that the figure covers medication only and that an active Weight Loss Membership, billed separately, is required.The lowest of the 4 medication prices we captured here | Every medication price sits on one page, and the footnote under the grid is the part that matters: the $149 headline is medication only and the required membership renews at $149 on top. | See its prices at Hims (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.