GLP-1 access guide
Does Medicaid cover Wegovy in my state?
Some state Medicaid programs list Wegovy for weight-management coverage subject to clinical criteria; North Carolina’s October 2026 preferred-drug list is one current example. Your own benefit still depends on the state program, plan, prescribed presentation and authorization, so an individual coverage decision needs those details rather than a national yes-or-no claim. [5][1]
Identify the state program and the benefit administrator
Use the state information available through Medicaid.gov to find the official program, then use the contact or portal on your enrollment materials. If a managed-care plan handles your benefits, ask which organization administers outpatient prescription claims. A statement about a state’s overall policy can leave important plan-specific details unresolved. [1]
Request a dated policy for Wegovy, including the exact presentation on the prescription. Check whether the information refers to the state’s fee-for-service program, your managed-care benefit or a separate initiative. A news story about state coverage may describe only one of those settings or an earlier policy period. [1][2]
What the BALANCE announcement does and does not establish
CMS describes BALANCE as a model involving participating manufacturers and states. Its Medicaid coverage depends on that participation and negotiated qualifications, including authorization requirements. CMS expressly says it does not guarantee coverage for any individual. The existence of the model is therefore not evidence that your state or plan will pay your pharmacy claim. [2]
Ask the state program whether it participates, when any applicable arrangement begins, and which products and conditions its current policy covers. Keep planned changes distinguishable from operative coverage. This directory does not maintain a verified fifty-state Medicaid formulary table, so it should not be used as a substitute for your program’s current documents. [2]
Questions to ask before an enrollment or pharmacy payment
Ask whether the named prescription is covered, what authorization the clinician must submit, which pharmacies can process it, and whether any patient payment applies. Ask where to find the appeal or review instructions if the request is denied. These are administrative questions; your clinician and program must address the patient-specific medical requirements. [1][2]
Then ask the telehealth provider whether it accepts your exact coverage for clinical care and whether it supports prescriptions through the required pharmacy route. A service that accepts Medicaid generally does not necessarily offer your proposed product under that benefit. Obtain the visit-fee policy as well as the medication-claim information. [1][3]
Keep state access separate from insurance coverage
Our location pages list provider-advertised services and state-specific evidence. They do not establish Medicaid payment for a prescription. A provider can serve a state without accepting the state’s Medicaid benefit, and a covered drug can still require an eligible clinician and dispensing route. Keep those checks in separate columns when researching options. [1]
Do not assume a commercial manufacturer savings card can cover a Medicaid transaction. The Mounjaro card, for example, expressly excludes government-funded program beneficiaries; other programs have their own terms. Ask your program and pharmacy about authorized payment options rather than assuming a discount automatically stacks on your benefit. [4]
A current state document is stronger than an old coverage headline
North Carolina illustrates how policy timing can change the answer. Its December 19, 2025 notice announced reinstatement of weight-management GLP-1 coverage effective December 12, 2025, after an earlier removal. The notice identified Wegovy and described authorization requirements. The current October 2026 preferred-drug list includes Wegovy presentations in the relevant weight-management class, with clinical criteria still applying. A reader stopping at the earlier withdrawal headline could therefore miss a subsequent change. This is a dated state example, not a conclusion about every Medicaid program. [6][5]
The state’s preferred-drug-list page distinguishes the current October document from archived 2026 and earlier lists. That version information is a practical part of the coverage check. Record the effective date and any revision date when you download a policy. A document can be authentic and still be outdated for the transaction you are researching. The latest list, associated clinical criteria and your plan’s response together are more useful than a table that gives one undated yes or no for each state. [7]
Keep the presentation visible in the state example. A coverage policy can identify pens, tablets or another named package separately. A broad ingredient search is not enough to establish the treatment of every product containing that ingredient. Ask the plan to match the exact prescribed brand and form to its current rules. The program and prescribing team handle clinical criteria; this guide explains how to locate and read the administrative evidence without deciding whether a particular person meets those requirements. [5][1]
Why a federal initiative does not replace the state check
BALANCE involves state and manufacturer participation and negotiated terms. CMS explicitly warns that it does not guarantee coverage for an individual. That matters when a national announcement is summarized as if all Medicaid beneficiaries now have the same GLP-1 benefit. Ask your state whether an applicable arrangement is operative and which product policies govern your plan. A planned participation date and an effective benefit are different facts. This article does not treat a federal model announcement as a verified fifty-state coverage roster. [2]
The Medicare GLP-1 Bridge is not the same Medicaid program. Although both initiatives appear in discussions of GLP-1 affordability, the Bridge serves qualifying Medicare Part D beneficiaries under its own terms. Someone with Medicaid should not borrow the Bridge copayment or product list as a Medicaid quote. If you have more than one type of coverage, ask the benefits administrator which payer and program apply to the actual prescription. Identifying the benefit first prevents a superficially similar federal announcement from being used as the wrong eligibility evidence. [2]
Before paying a telehealth enrollment charge, obtain the state or managed-care policy, the prescription-specific authorization process and the provider’s service-fee terms. The provider’s ability to serve your state is an access fact; its ability to process your Medicaid clinical visit or pharmacy prescription is a payment fact. Our state pages can help with the first question, but the program and pharmacy must answer the second. A named provider in a directory is not evidence that your Medicaid claim will be paid. [1][3]
Wegovy access and Medicaid evidence by state
The table covers 51 jurisdictions: 46 have a reviewed Medicaid access fact and 5 have no such fact in our current records. “Not established” means the evidence is incomplete; it does not mean coverage is denied. These facts come from the directory’s reviewed medication-state records. They describe the scope of the cited policy, which may be an anti-obesity-drug exclusion rather than a Wegovy-specific rule. The check date is the source record’s date; October’s article preparation does not refresh September’s evidence. A state’s fact is not your plan’s individual coverage decision.
| State | Reviewed access fact | Primary source / checked | Directory page |
|---|---|---|---|
| Alabama | Alabama Medicaid does not cover Wegovy for weight reduction; it is available with prior authorization for its cardiovascular and MASH uses. Prior authorization requires documentation of the FDA-approved use: adults with established cardiovascular disease and obesity or overweight, or noncirrhotic MASH with moderate to advanced fibrosis and no diabetes. Since October 1, 2026, Wegovy is no longer on the preferred drug list, the cardiovascular route also requires a BMI of 27 or more, and renewals must show adequate weight loss. These are Alabama Medicaid's rules for its members; they do not mean the providers listed here accept Alabama Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Alabama Medicaid Agency Preferred Drug List (PDL) Reference Tool Alabama Medicaid Agency Preferred Drug List (PDL) Reference Tool ALERT: Preferred Drug List (PDL) and Pharmacy Quarterly Update | Wegovy in Alabama |
| Alaska | Alaska Medicaid does not pay for drugs used to treat obesity. These are Alaska Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Alaska | |
| Arizona | Arizona's Medicaid program (AHCCCS) excludes medications used for weight loss, in both fee-for-service and its managed care plans, and Wegovy is not on the AHCCCS drug list; drugs not on the list can be requested through prior authorization. The fee-for-service criteria cover Wegovy (injection or tablet) for cardiovascular risk reduction; they include age 45 or older, a BMI of 30 or more, established cardiovascular disease shown by a prior heart attack or certain listed diagnoses, a reduced-calorie diet and more physical activity, no diabetes (A1c under 6.5%), no class IV heart failure and no end-stage kidney disease. After a heart attack, the person must also be on a medicine from each of four standard heart-drug classes, or have a documented intolerance or contraindication to all of them. Cardiovascular approvals last 6 months. The injection is also covered for MASH with moderate to advanced fibrosis, prescribed by or with a gastroenterologist, hepatologist or endocrinologist. These are AHCCCS's rules for its members; they do not mean the providers listed here accept AHCCCS, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | AHCCCS Medical Policy Manual 310-V - Prescription Medications/Pharmacy Services AHCCCS Acute - Long Term Care Drug List (Effective September 1, 2026) | Wegovy in Arizona |
| Arkansas | Arkansas Medicaid does not cover medications for weight loss; its prior authorization criteria cover Wegovy injection and tablets for cardiovascular risk reduction. These are Arkansas Medicaid's rules for its members, not a sign that the providers listed here accept it. | Arkansas DHS Division of Medical Services Provider Memorandum (DUR Board April 15, 2026) | Wegovy in Arkansas |
| California | Medi-Cal Rx stopped covering GLP-1 drugs, including Wegovy, for weight loss on January 1, 2026 for members 21 and older. Requests for members younger than 21 are reviewed for medical necessity under the federal EPSDT benefit, so coverage is not automatic. Prior authorization requests for other uses, such as cardiovascular disease, are reviewed case by case for medical necessity, and since April 1, 2026 Wegovy prescribed for noncirrhotic MASH does not need prior authorization. These are Medi-Cal's rules for its members; they do not mean the providers listed here accept Medi-Cal, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Medi-Cal Rx Contract Drugs List (September 1, 2026) Medi-Cal Rx alert: GLP-1 Coverage Considerations (updated April 6, 2026) Medi-Cal Rx alert: Changes to GLP-1 Drug Coverage for Wegovy (April 6, 2026) | Wegovy in California |
| Colorado | Colorado Medicaid (Health First Colorado) does not cover drugs used for weight loss. On its fee-for-service drug list, Wegovy (pen or pill) is a preferred drug for cardiovascular risk reduction, with criteria that include age 18 or older, established cardiovascular disease with obesity or overweight, no type 2 diabetes, and counseling on diet and exercise. GLP-1 drugs approved for MASH are also covered with criteria, including a specialist as prescriber or consultant. The two Medicaid managed care plans, Rocky Mountain Health Plans and Denver Health, use their own drug lists. These are Health First Colorado's rules for its members; they do not mean the providers listed here accept Health First Colorado, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Colorado Department of Health Care Policy and Financing Preferred Drug List (PDL) | Wegovy in Colorado |
| Connecticut | Connecticut Medicaid (HUSKY Health) does not cover Wegovy exclusively for weight management; its October 2025 bulletin describes Wegovy coverage for MASH and cardiovascular risk reduction. These are HUSKY Health's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Connecticut | |
| Delaware | Delaware Medicaid lists Wegovy in its obesity treatment drug class, where all drugs require prior authorization. These are Delaware Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Delaware | |
| District of Columbia | DC Medicaid's drug list excludes anti-obesity drugs. These are DC Medicaid's rules for its members, not a sign that the providers listed here accept it. | District of Columbia Department of Health Care Finance Pharmacy Preferred Drug List | Wegovy in District of Columbia |
| Florida | Florida Medicaid's prescribed-drug coverage policy excludes weight-control medications, and Wegovy does not appear on the Florida Medicaid Preferred Drug List effective July 1, 2026. Florida Medicaid's GLP-1 prior authorization criteria, revised March 12, 2026, list Mounjaro, Ozempic and Trulicity as preferred agents for people with type 2 diabetes. These are Florida Medicaid's rules for its members; they do not mean the providers listed here accept Florida Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Florida Medicaid Prescribed Drug Services Coverage Policy (Rule 59G-4.250) Florida Medicaid Preferred Drug List (effective July 1, 2026) Florida Medicaid prior authorization criteria: GLP-1 receptor agonists (revised March 12, 2026) | Wegovy in Florida |
| Georgia | Georgia Medicaid's preferred drug list (effective September 1, 2026) and its prior authorization criteria cross-reference do not list Wegovy. The weight-loss drugs Georgia Medicaid does list, Saxenda and Xenical, are not covered for members 18 and older and need prior authorization for ages 12 to 17. The preferred drug list says it does not include every covered drug, and Georgia's Medicaid care management organizations have their own prior approval processes and criteria. These are Georgia Medicaid's rules for its members; they do not mean the providers listed here accept Georgia Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Georgia Medicaid/PeachCare for Kids Preferred Drug List, alphabetical (effective September 1, 2026) Georgia Medicaid Prior Authorization Drug Criteria Cross Reference (alphabetical by drug name) Georgia Medicaid Fee-for-Service Antihyperlipidemics, Other PA Summary (Xenical and Saxenda) Georgia Medicaid Fee-for-Service Pharmacy Prior Authorization Request Process Guide | Wegovy in Georgia |
| Hawaii | Not established in our current reviewed records. Check your Medicaid plan’s current drug list and authorization rules. | No reviewed Medicaid access source or check date recorded. | Wegovy in Hawaii |
| Idaho | Not established in our current reviewed records. Check your Medicaid plan’s current drug list and authorization rules. | No reviewed Medicaid access source or check date recorded. | Wegovy in Idaho |
| Illinois | Not established in our current reviewed records. Check your Medicaid plan’s current drug list and authorization rules. | No reviewed Medicaid access source or check date recorded. | Wegovy in Illinois |
| Indiana | Indiana Medicaid excludes drugs used to promote weight loss, and Wegovy is not covered exclusively for weight loss. It is a non-preferred drug covered with prior authorization for cardiovascular risk reduction (injection or pill) and, injection only, for MASH. The cardiovascular criteria include age 45 or older, a BMI of 27 or more, a prior heart attack, stroke or symptomatic peripheral arterial disease, guideline-directed heart therapy or a documented reason it cannot be used, and no type 1 or type 2 diabetes. MASH requires confirmation by liver biopsy or elastography and a prescriber who is, or consults, an endocrinologist, gastroenterologist or hepatologist. The pill also requires a documented reason to use it instead of the injection. These are Indiana Medicaid's rules for its members; they do not mean the providers listed here accept Indiana Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Indiana Medicaid Statewide Uniform Preferred Drug List (SUPDL), p. 39 Criteria for Indiana Medicaid: GLP-1 Receptor Agonists and Combinations | Wegovy in Indiana |
| Iowa | Iowa Medicaid denies payment for medications used solely for weight loss, which is an excluded use under state rules. These are Iowa Medicaid's rules for its members, not a sign that the providers listed here accept it. | Iowa Medicaid Drug Prior Authorization Criteria: Incretin Mimetics for Non-Diabetes Indications | Wegovy in Iowa |
| Kansas | Kansas Medicaid covers Wegovy as an anti-obesity medication with prior authorization. These are Kansas Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Kansas | |
| Kentucky | Kentucky Medicaid excludes drugs used for weight loss unless its drug list designates them as covered, and its Wegovy prior authorization criteria cover cardiovascular risk reduction and MASH. These are Kentucky Medicaid's rules for its members, not a sign that the providers listed here accept it. | 907 KAR 23:010. Outpatient Pharmacy Program Prior Authorization Criteria, Kentucky Medicaid: Wegovy (semaglutide) | Wegovy in Kentucky |
| Louisiana | Louisiana Medicaid excludes drugs used for weight loss, except orlistat. It covers Wegovy with clinical authorization for cardiovascular risk reduction (injection or pill) and, injection only, for MASH, under one drug list for fee-for-service and Healthy Louisiana plans. The cardiovascular criteria include age 45 or older, a BMI of 27 or more (with a bariatric surgery evaluation or referral at a BMI of 35 or more), a prior heart attack, stroke or symptomatic peripheral arterial disease with specific heart treatments, and no diabetes. A signed treatment agreement is required with the first request. These are Louisiana Medicaid's rules for its members; they do not mean the providers listed here accept Louisiana Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List (NPDL) | Wegovy in Louisiana |
| Maine | MaineCare's drug list has criteria for Wegovy to reduce major cardiovascular events, including that it is not being used for weight loss only. These are MaineCare's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Maine | |
| Maryland | Maryland Medicaid does not cover drugs used for weight control. It covers the Wegovy injection with prior authorization for cardiovascular risk reduction and for MASH, and the Wegovy pill for cardiovascular risk reduction; according to the state's drug review board, all nine HealthChoice managed care organizations also cover the injection for both uses. Under the fee-for-service criteria, the cardiovascular requirements include age 18 or older, a cardiologist as prescriber or consultant, a BMI of 27 or more, and a history of heart attack, stroke or symptomatic peripheral arterial disease. MASH requires a gastroenterologist or hepatologist as prescriber or consultant and moderate to advanced fibrosis confirmed within the last 180 days. Fee-for-service approvals last 4 months at first, then 6 months. A 2026 law allows, but does not require, Medicaid to cover obesity treatment starting January 1, 2027. These are Maryland Medicaid's rules for its members; they do not mean the providers listed here accept Maryland Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Maryland Medicaid Pharmacy Program Clinical Criteria: Wegovy tablet (semaglutide) Office of Pharmacy Services, Medicaid Pharmacy Program - Drug Use Review (DUR) Board Meeting Minutes Office of Pharmacy Services, Medicaid Pharmacy Program - Drug Use Review (DUR) Board Meeting Minutes COMAR 10.09.03.05 Limitations (Medical Care Programs - Pharmacy Services) | Wegovy in Maryland |
| Massachusetts | Not established in our current reviewed records. Check your Medicaid plan’s current drug list and authorization rules. | No reviewed Medicaid access source or check date recorded. | Wegovy in Massachusetts |
| Michigan | Michigan Medicaid covers Wegovy with clinical prior authorization, with approvals of 6 months. For weight loss alone, state budget law has limited coverage since January 1, 2026 to people classified as morbidly obese (for adults, for example, a BMI of 40 or more). In that use Wegovy is non-preferred. Among the criteria: all five types of preferred weight-loss drugs must have been tried without success, or be ruled out by allergy, contraindication or drug interaction, or by unacceptable side effects; and the prescriber must attest that other clinically appropriate weight-loss interventions have failed and that the drug is used only to avoid higher-cost bariatric surgery. For cardiovascular risk reduction (criteria include adults with established cardiovascular disease and a BMI of 27 or more) and for a specific liver disease (MASH), Wegovy is a preferred drug. Medicaid health plans may be less restrictive than these rules, but not more. The budget law for the fiscal year starting October 1, 2026 keeps a similar limit, worded as class III obesity, only if the state does not join a federal pharmaceutical savings program. These are Michigan Medicaid's rules for its members; they do not mean the providers listed here accept Michigan Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Michigan Single Preferred Drug List (effective September 1, 2026) Michigan Medicaid Clinical and PDL Criteria (revised September 1, 2026) MDHHS Numbered Letter L 25-73: Update of Pharmacy Drug Coverage for Treatment of Obesity Michigan Public Act 22 of 2025 (fiscal year 2026 appropriations), section 1880(2) Michigan Public Act 21 of 2026 (fiscal year 2027 appropriations), section 1880(2) Michigan Medicaid Provider Manual, Pharmacy chapter (July 1, 2026) | Wegovy in Michigan |
| Minnesota | Minnesota's uniform preferred drug list, which fee-for-service and managed care Medicaid both use, lists the Wegovy injection as a preferred drug in its weight-management class. State law used to exclude weight-loss drugs from Medical Assistance, but that exclusion was removed in 2021. These are Minnesota Medical Assistance's rules for its members; they do not mean the providers listed here accept Minnesota Medical Assistance, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | MN Uniform Preferred Drug List - Effective August 4, 2026 Minn. Stat. 256B.0625 (2020), subd. 13d Drug formulary Laws 2021, First Special Session chapter 7, art. 1, sec. 10 (amending 256B.0625 subd. 13d) | Wegovy in Minnesota |
| Mississippi | Mississippi Medicaid covers select obesity medications, including Wegovy for ages 12 and older, with prior authorization. These are Mississippi Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Mississippi | |
| Missouri | Missouri Medicaid (MO HealthNet) historically excluded anti-obesity drugs but now covers selected ones; in that class Foundayo and Zepbound are preferred and Wegovy is non-preferred, so a Wegovy request needs a medical reason why a preferred drug cannot be used. The criteria include, for adults, a BMI of 30 or more, a BMI of 27 or more with a listed weight-related condition, or MASH with moderate to advanced fibrosis, and a BMI at or above the 95th percentile for ages 12 to 17. Wegovy also has its own routes for cardiovascular risk reduction (age 45 and older) and MASH, both for people without diabetes. Approvals are issued 4 weeks at a time while the dose is increased. Managed care plans do not provide pharmacy services, so these fee-for-service criteria apply to their members too. MO HealthNet's August 2026 pharmacy manual lists only preferred GLP-1s as exceptions to its weight-loss exclusion, while its April 2026 criteria document still lists criteria for Wegovy, so confirm current coverage with MO HealthNet. These are MO HealthNet's rules for its members; they do not mean the providers listed here accept MO HealthNet, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit MO HealthNet Pharmacy Provider Manual, Section 2.9 Managed Care Health Plan Pharmacy Services | Wegovy in Missouri |
| Montana | Montana Medicaid does not cover drugs prescribed for weight reduction; its drug review board approved Wegovy criteria for cardiovascular risk reduction and MASH in November 2025. These are Montana Medicaid's rules for its members, not a sign that the providers listed here accept it. | 2026 Montana Medicaid Member Guide (DPHHS) Montana Healthcare Programs November 2025 DUR Board Meeting Minutes | Wegovy in Montana |
| Nebraska | Nebraska Medicaid's prior authorization form covers Wegovy for reducing the risk of major cardiovascular events and for MASH in adults. These are Nebraska Medicaid's rules for its members, not a sign that the providers listed here accept it. | Nebraska Medicaid Request for Prior Authorization: Wegovy (semaglutide) | Wegovy in Nebraska |
| Nevada | Nevada Medicaid has prior-authorization coverage for Wegovy to reduce the risk of major cardiovascular events. These are Nevada Medicaid's rules for its members, not a sign that the providers listed here accept it. | Medicaid Services Manual Chapter 1200 Prescribed Drugs, Appendix A: Incretin Mimetics | Wegovy in Nevada |
| New Hampshire | Since January 1, 2026, New Hampshire Medicaid no longer covers GLP-1 drugs prescribed solely for weight loss; coverage for other chronic conditions is unchanged. These are New Hampshire Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in New Hampshire | |
| New Jersey | New Jersey's Medicaid State Plan excludes drugs used for weight loss, and the State's Drug Utilization Review Board notes these drugs are not covered for obesity alone. Wegovy is covered with prior authorization under Board protocols for cardiovascular risk reduction (approved by the Commissioners by April 2025) and, through an addendum approved by April 2026, for MASH; the protocol text itself is not published. NJ FamilyCare health plans must keep their drug review standards consistent with the Board's. As an example, Horizon NJ Health's policy (effective July 13, 2026) includes, for cardiovascular use, adults with established cardiovascular disease and a BMI of 27 or more, prescribed by or with a cardiologist, vascular specialist or endocrinologist, with approvals of up to 6 months; its MASH coverage is for the injection only, and its weight-loss exclusion applies to members 21 and older. These are NJ FamilyCare's rules for its members; they do not mean the providers listed here accept NJ FamilyCare, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | July 17, 2024, DURB Meeting Summary April 23, 2025, DURB Meeting Summary (Secretary's Report) October 22, 2025, DURB Meeting Summary April 15, 2026, DURB Meeting Summary (Secretary's Report) Horizon NJ Health Pharmacy Policy: AOMs and GLP-1 Agonists for Non-Diabetic Use | Wegovy in New Jersey |
| New Mexico | New Mexico Medicaid lists Wegovy among the weight reduction medications it does not cover. These are New Mexico Medicaid's rules for its members, not a sign that the providers listed here accept it. | Weight Reduction Medications, New Mexico Health Care Authority | Wegovy in New Mexico |
| New York | New York Medicaid (NYRx) does not pay for drugs used for weight loss, citing federal law. Since November 20, 2025 it has covered Wegovy with prior authorization for cardiovascular risk reduction. The current criteria require a diagnosis of cardiovascular disease, a BMI of 40 or more, and participation in lifestyle changes that support heart health, with a limit of two treatment attempts per lifetime. These are NYRx's rules for its members; they do not mean the providers listed here accept NYRx, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | NYRx, the Medicaid Drug Program: Preferred Drug List (revised September 14, 2026) NYRx Drug Coverage Overview: Wegovy (11/20/25, rev. 07/23/26) | Wegovy in New York |
| North Carolina | NC Medicaid covers Wegovy for weight management with prior authorization. That coverage began August 1, 2024, was discontinued October 1, 2025 because of state funding shortfalls, and was reinstated effective December 12, 2025 under the earlier criteria, with Wegovy as the preferred product. For adults, the criteria include a BMI of 30 or more, or 27 or more with a weight-related condition, a baseline weight and BMI measured within 45 days, and ongoing lifestyle changes; ages 12 to 17 have separate criteria. Initial approval lasts 6 months and renewals 12 months. To renew, adults usually need to have kept off at least 5% of their starting weight; a smaller maintained loss can also qualify if the prescriber documents why it is a significant reduction. NC Medicaid also covers Wegovy for its other FDA-approved uses, and these rules apply to both NC Medicaid Direct and NC Medicaid Managed Care. These are NC Medicaid's rules for its members; they do not mean the providers listed here accept NC Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | NC Medicaid to Add Coverage for Obesity Management Medications NC Medicaid to Change Coverage for GLP-1 Weight Management Medications NC Medicaid to Reinstitute Coverage of GLP-1s for Weight Management NC Medicaid Pharmacy Newsletter Number 387 (February 2026) North Carolina Medicaid Preferred Drug List (effective July 2026, revised July 24, 2026) | Wegovy in North Carolina |
| North Dakota | Not established in our current reviewed records. Check your Medicaid plan’s current drug list and authorization rules. | No reviewed Medicaid access source or check date recorded. | Wegovy in North Dakota |
| Ohio | Ohio Medicaid does not cover drugs for the treatment of obesity, and its rules make them ineligible for prior authorization. Since April 1, 2026 it has covered Wegovy with clinical prior authorization for other approved uses: reducing the risk of major adverse cardiovascular events in adults, and a specific liver disease (MASH). The cardiovascular criteria exclude people with type 1 or type 2 diabetes, who are directed to the diabetes drug category; that exclusion is not part of the MASH criteria. Approvals last 180 days. The Wegovy pill was added on July 1, 2026, and the 7.2 mg injection strength is not included. One preferred drug list covers both fee-for-service and managed care plans. These are Ohio Medicaid's rules for its members; they do not mean the providers listed here accept Ohio Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Ohio Administrative Code 5160-9-03, Pharmacy services: covered drugs and associated limitations | Wegovy in Ohio |
| Oklahoma | Oklahoma Medicaid (SoonerCare) does not approve Wegovy for obese or overweight members without established cardiovascular disease or MASH. These are SoonerCare's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Oklahoma | |
| Oregon | Outside its EPSDT review pathway, the Oregon Health Plan does not cover drugs prescribed for weight management alone for adults. These are the Oregon Health Plan's rules for its members, not a sign that the providers listed here accept it. | Oregon Medicaid PA Criteria Guide, July 1, 2026 (Weight Management Drugs) | Wegovy in Oregon |
| Pennsylvania | Pennsylvania Medical Assistance stopped covering GLP-1 drugs, including Wegovy, for overweight or obesity on January 1, 2026. They remain covered for other medically accepted uses with prior authorization, and every GLP-1 prescription needs prior authorization; for cardiovascular risk reduction, the criteria include prescribing by or with an appropriate specialist and a recent BMI of 27 or more. These are Pennsylvania Medical Assistance's rules for its members; they do not mean the providers listed here accept Pennsylvania Medical Assistance, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Wegovy in Pennsylvania | |
| Rhode Island | Rhode Island Medicaid requires clinical prior authorization for its weight-management drug class. Since October 1, 2026, it no longer covers certain GLP-1 drugs prescribed solely for weight loss, and other uses need a new prior authorization request. These are Rhode Island Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Rhode Island | |
| South Carolina | South Carolina Medicaid does not cover weight-control products, and it removed GLP-1 drugs for obesity from its preferred drug list at the end of 2025. The state told its pharmacy committee that Wegovy remains covered for other uses, such as cardiovascular risk reduction and MASH, with prior authorization. Members of managed care plans go through their plan's own prior authorization process. These are South Carolina Medicaid's rules for its members; they do not mean the providers listed here accept South Carolina Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Pharmacy Services Provider Manual (South Carolina Department of Health and Human Services) SCDHHS Pharmacy and Therapeutics (P&T) Committee Meeting Minutes | Wegovy in South Carolina |
| South Dakota | South Dakota Medicaid does not cover drugs used for weight loss. These are South Dakota Medicaid's rules for its members, not a sign that the providers listed here accept it. | South Dakota Medicaid Billing and Policy Manual: Pharmacy Services | Wegovy in South Dakota |
| Tennessee | TennCare has covered medicines for obesity since August 1, 2025, and the Wegovy injection is a preferred drug that needs prior authorization. For weight management the criteria include, for adults, a BMI over 30, or over 27 with a weight-related condition (ages 12 to 17 use BMI percentile), participation in nutrition and lifestyle changes, and no combination with other obesity drugs; renewal requires at least 5% weight loss for adults (children use BMI-for-age), and approvals generally last one year. The injection is also covered for cardiovascular risk reduction and for MASH, with separate criteria; MASH requires a gastroenterologist or hepatologist's involvement. The Wegovy pill is covered for cardiovascular risk reduction only as a non-preferred drug with a documented contraindication to the injection's ingredients, and for weight management the pill and Wegovy HD are not covered for members 21 and older. These are TennCare's rules for its members; they do not mean the providers listed here accept TennCare, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Clinical Criteria, Step Therapy, and Quantity Limits for TennCare Preferred Drug List (PDL) TennCare Non-PDL (Preferred Drug List) Agents: Clinical Criteria, Step Therapy, and Quantity Limits TennCare provider notice: TennCare Pharmacy Coverage of Obesity Management Agents | Wegovy in Tennessee |
| Texas | Texas Medicaid covers Wegovy only with clinical prior authorization. The criteria include a cardiovascular route for people 45 or older with cardiovascular disease and an obesity or overweight diagnosis, and a route for adults with non-cirrhotic MASH and moderate to advanced liver fibrosis (injection only); weight loss alone does not qualify. Approvals last up to 365 days. Medicaid managed care plans are also required to perform clinical prior authorization for Wegovy, so members should check their plan's process. The Wegovy pill has been on the formulary since August 11, 2026. These are Texas Medicaid's rules for its members; they do not mean the providers listed here accept Texas Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Texas Vendor Drug Program: HHSC Reviews, Updates Clinical Prior Authorization Criteria Guides Texas Vendor Drug Program: Clinical Prior Authorizations for Managed Care | Wegovy in Texas |
| Utah | Since June 30, 2026, Utah Medicaid fee-for-service no longer covers GLP-1 drugs, including Wegovy, for weight loss. These are Utah Medicaid's rules for its members, not a sign that the providers listed here accept it. | Medicaid Information Bulletin: May 2026 (26-45 GLP-1 Agonists for Weight Loss) | Wegovy in Utah |
| Vermont | Vermont Medicaid excludes drugs used for weight loss, and its Wegovy criteria require that the drug not be used for weight loss only. These are Vermont Medicaid's rules for its members, not a sign that the providers listed here accept it. | Vermont PDL (DVHA Preferred Drug List and Clinical Criteria) | Wegovy in Vermont |
| Virginia | Virginia Medicaid covers Wegovy with service authorization, and it is not among the preferred weight-management drugs; the same preferred drug list and criteria apply in fee-for-service and managed care. For weight loss, the criteria include a BMI over 40, or over 37 with dyslipidemia, hypertension or type 2 diabetes; a failed trial of one non-GLP-1 weight-loss drug, or intolerance to all of them; nutritional counseling and a physical activity program (unless medically contraindicated); and documentation from the last 60 days. Approvals last 6 months, renewal requires at least a 5% weight reduction compared with the last approval, and renewals stop once BMI is under 25. The Wegovy pill additionally needs a medical contraindication to injectable products or failed trials of two. For cardiovascular risk reduction the criteria include age 45 or older, a cardiologist or vascular specialist as prescriber, a prior heart attack, stroke or peripheral artery disease, a BMI of 27 or more, and no diabetes diagnosis; MASH has its own criteria and requires a liver specialist's involvement. The 2026 state budget directs Medicaid to pursue a lower GLP-1 price and sets different weight-loss coverage rules depending on the result, which requires further Medicaid action. These are Virginia Medicaid's rules for its members; they do not mean the providers listed here accept Virginia Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | DMAS Service Authorization (SA) Form: Weight-Loss Management Virginia Preferred Drug List (PDL) / Common Core Formulary QuickList Virginia Medicaid Provider Manual: Pharmacy, Chapter IV: Covered Services and Limitations | Wegovy in Virginia |
| Washington | Washington Apple Health does not cover Wegovy for weight loss; a noncovered drug can be requested through the exception-to-rule process, and clients 20 and younger fall under EPSDT rules. It covers Wegovy with prior authorization for cardiovascular risk reduction (injection or tablet) and, injection only, for MASH with moderate to advanced fibrosis. The cardiovascular criteria include age 18 or older, a BMI of 27 or more, no diabetes or A1c above 6.5% (those patients are directed to the diabetes GLP-1 policy), established cardiovascular disease, and ongoing antiplatelet, blood pressure or cholesterol-lowering treatment unless contraindicated or not tolerated. Initial approvals last 6 months and renewals 12 months, and a clinical reviewer may approve case by case for medical necessity when not all criteria are met. All Apple Health plans use the same preferred drug list and prior authorization criteria. These are Apple Health's rules for its members; they do not mean the providers listed here accept Apple Health, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | Wegovy in Washington | |
| West Virginia | West Virginia Medicaid treats weight-loss drugs as a benefit exclusion and considers Wegovy only for secondary prevention of cardiovascular events or MASH. These are West Virginia Medicaid's rules for its members, not a sign that the providers listed here accept it. | WV BMS Office of Pharmacy Services Prior Authorization Criteria – Wegovy (semaglutide) | Wegovy in West Virginia |
| Wisconsin | Since July 1, 2026, Wisconsin Medicaid (ForwardHealth) approves the Wegovy injection only to reduce the risk of major cardiovascular events in adults with established cardiovascular disease, to treat MASH in adults, or for weight reduction in children aged 12 to 17 with obesity, and the Wegovy pill only for the cardiovascular use; adult weight loss alone is not an approvable use. The cardiovascular criteria include a prior heart attack, stroke or peripheral arterial disease, a BMI of 27 or more, and agreement to a reduced-calorie diet and more physical activity. MASH requires a prescription from a liver specialist such as a gastroenterologist or hepatologist, and the pediatric criteria include a BMI at or above the 95th percentile. Adult weight-management drugs are a separate preferred drug list class limited to Foundayo and Zepbound. These rules also apply to BadgerCare Plus and SSI HMO members, whose pharmacy benefit is fee-for-service. These are Wisconsin Medicaid's rules for its members; they do not mean the providers listed here accept Wisconsin Medicaid, and whether a prescription is covered also depends on the person's plan, the use it is prescribed for and the formulation. | ForwardHealth Update No. 2026-15: July 2026 Preferred Drug List Changes and Other Pharmacy Policy ForwardHealth Online Handbook (Pharmacy), Topic #24323: Wegovy Injection and Wegovy Tablets ForwardHealth Online Handbook (Pharmacy), Topic #24303: Weight Management Agents | Wegovy in Wisconsin |
| Wyoming | Wyoming Medicaid's drug list covers Wegovy injections with clinical criteria requiring a MASH diagnosis and points to separate criteria for cardiovascular disease. These are Wyoming Medicaid's rules for its members, not a sign that the providers listed here accept it. | Wegovy in Wyoming |
Additional reading from a provider
These pages describe a provider’s perspective or its own service. The official documents cited in this guide establish regulatory, approval and program facts.
- Gentle Health: insurance-denial discussion (provider-authored)
A general provider-authored coverage-denial checklist, not a source for individual state Medicaid benefits or the state table above.
Checked
Sources
Sources are checked on the dates shown. Official documents establish product and program rules; provider sources describe their own offers and the additional reading identified above. Provider catalog examples retain their original price-check dates; this article’s preparation date does not refresh them.
- Medicaid.gov: state profiles — checked .
- CMS: BALANCE model participation and coverage — checked .
- FTC: trials, automatic renewals and subscriptions — checked .
- Lilly: Mounjaro savings card eligibility — checked .
- NC Medicaid preferred-drug list, effective October 1, 2026 — checked .
- NC Medicaid: coverage reinstatement notice, December 19, 2025 — checked .
- NC Medicaid: current and archived preferred-drug lists — checked .
- Gentle Health: insurance-denial discussion (provider-authored) — checked .