Does Medicaid Cover GLP-1? Criteria, Copay, How to Appeal
Every state Medicaid program covers GLP-1s for type 2 diabetes. For weight loss, 10 states cover them as of November 2026, most with prior authorization.
- States covering weight loss
- 10
- Covered for type 2 diabetes
- Every state
- States covering in January 2026
- 13
- Prior authorization
- Typical
Does Medicaid cover GLP-1?
| Medicine | Approved for | Medicaid covers it in | More |
|---|---|---|---|
 Ozempic | Type 2 diabetes, plus heart risk and kidney disease in people with type 2 diabetes | Every state | By state |
 Wegovy | Weight loss, heart risk and MASH liver disease | 10 states | By state |
 Mounjaro | Type 2 diabetes and heart risk | Every state | By state |
 Zepbound | Weight loss and sleep apnea | 10 states | By state |
 Foundayo | Weight loss | 10 states | Not listed |
 Rybelsus | Type 2 diabetes and heart risk | Every state | By state |
 Trulicity | Type 2 diabetes and heart risk | Every state | By state |
 Saxenda | Weight loss | 10 states | By state |
 Victoza | Type 2 diabetes and heart risk | Every state | By state |
For weight loss, coverage now includes GLP-1s in these places: Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Tennessee, Virginia, and Wisconsin.
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.
The published policy, as written
- Must states cover diabetes GLP-1s?
- 16 states covered weight loss in October 2025
- Weight loss: January 2026, 13 states had coverage
- Prior authorization: Required
- Changes in 2026:
- Since January 2026, Michigan's coverage rules have tightened (effective January 1, 2026)
- In Pennsylvania, coverage stopped in January 2026 (effective January 1, 2026)
- In June 2026, the pilot program in Utah ended (effective June 30, 2026)
- Wisconsin coverage requires prior authorization beginning July 1, 2026
- In Massachusetts, coverage stopped in July 2026 (effective July 3, 2026)
- Rhode Island saw the end of its coverage in October 2026 (effective October 1, 2026)
Read the complete policy at KFF.
Sources: KFF, michigan.gov, pa.gov, medicaid-documents.dhhs.utah.gov.
Prior authorization checklist
- Prior authorization: Required
- Records you need include your height and weight measurements, any weight-related conditions, and the diet and activity program you tried.
- Your prescriber files the prior authorization. You do not file it.
Source: KFF.
The appeal: if you are denied
| Denial reason | What to send or ask |
|---|---|
| Criteria not met | Ask your prescriber to send the request once more, listing your measured BMI and each weight-related condition noted in your chart. |
| The drug is not on the plan's list | Also ask which alternative GLP-1 your plan prefers. |
- The unmet rule is named in the denial notice from your Medicaid plan.
- Chart notes let your prescriber send the prior authorization again.
- You can ask for a state fair hearing when the plan still says no to coverage.
What differs by state and plan
| State | For weight loss | For type 2 diabetes | Prior authorization |
|---|---|---|---|
| Alabama | Not covered | Covered | Not listed |
| Alaska | Not covered | Covered | Not listed |
| Arizona | Not covered | Covered | Not listed |
| Arkansas | Not covered | Covered | Not listed |
| California | Ended January 2026 | Covered | Not listed |
| Colorado | Not covered | Covered | Not listed |
| Connecticut | Not covered | Covered | Not listed |
| Delaware | Covered with prior authorization | Covered | Required |
| District of Columbia | Not covered | Covered | Not listed |
| Florida | Not covered | Covered | Not listed |
| Georgia | Not covered | Covered | Not listed |
| Hawaii | Not covered | Covered | Not listed |
| Idaho | Not covered | Covered | Not listed |
| Illinois | Not covered | Covered | Not listed |
| Indiana | Joining BALANCE, start date not set | Covered | Not listed |
| Iowa | Not covered | Covered | Not listed |
| Kansas | Covered with prior authorization | Covered | Required |
| Kentucky | Not covered | Covered | Not listed |
| Louisiana | Not covered, law allows coverage from 2027 | Covered | Not listed |
| Maine | Not covered | Covered | Not listed |
| Maryland | Not covered | Covered | Not listed |
| Massachusetts | Ended July 2026 | Covered | Required |
| Michigan | Covered, tighter rules since January 2026 | Covered | Required |
| Minnesota | Covered with prior authorization | Covered | Required |
| Mississippi | Covered | Covered | Not listed |
| Missouri | Covered with prior authorization | Covered | Required |
| Montana | Not covered | Covered | Not listed |
| Nebraska | Not covered | Covered | Not listed |
| Nevada | Not covered | Covered | Not listed |
| New Hampshire | Ended January 2026 | Covered | Not listed |
| New Jersey | Not covered | Covered | Not listed |
| New Mexico | Not covered | Covered | Not listed |
| New York | Not covered | Covered | Not listed |
| North Carolina | Covered with prior authorization | Covered | Required |
| North Dakota | Not covered | Covered | Not listed |
| Ohio | Not covered | Covered | Not listed |
| Oklahoma | Not covered | Covered | Not listed |
| Oregon | Not covered | Covered | Not listed |
| Pennsylvania | Ended January 2026 | Covered | Not listed |
| Rhode Island | Ended October 2026 | Covered | Required |
| South Carolina | Ended January 2026 | Covered | Not listed |
| South Dakota | Not covered | Covered | Not listed |
| Tennessee | Covered with prior authorization | Covered | Required |
| Texas | Not covered | Covered | Not listed |
| Utah | Pilot ended June 2026 | Covered | Required |
| Vermont | Not covered | Covered | Not listed |
| Virginia | Covered with strict service authorization | Covered | Required |
| Washington | Not covered | Covered | Not listed |
| West Virginia | Not covered | Covered | Not listed |
| Wisconsin | Covered with prior authorization | Covered | Required |
| Wyoming | Not covered | Covered | Not listed |
Sources: KFF, medicaidpublications.dhss.delaware.gov, events.in.gov, kdhe.ks.gov.
Other options when coverage says no
| Medicine | Lowest self-pay | What the manufacturer offers if your plan will not cover it | Patient assistance |
|---|---|---|---|
| Ozempic | $149 a month | Not listed | Free if approved |
| Wegovy | $149 a month | Not listed | Not listed |
| Mounjaro | Not listed | $499 a month | Not listed |
| Zepbound | $299 a month | $299 a month | Not listed |
| Foundayo | $149 a month | Not listed | Not listed |
| Trulicity | Not listed | Not listed | Free for up to 12 months |
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.