Does Medicaid Cover Tirzepatide? 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
Zepbound overview
Its half-life is 5 to 6 days. After 5.5 d, half is gone, and about 3% remains after five half-lives (27.5 d).
Body weight loss in SURMOUNT-1 at 72 weeks: 20.9% compared with 3.1% on placebo.
In US dollars, the monthly figures include list prices and self-pay offers, with each amount taken from the maker's price page.
Sources: FDA label (DailyMed), Eli Lilly 1 2, cnbc.com.
Does Medicaid cover tirzepatide?
For weight loss, these states currently cover GLP-1s: Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Tennessee, Virginia, Wisconsin.
Sources: pricinginfo.lilly.com, mounjaro.lilly.com, GoodRx, zepbound.lilly.com.
Published policy
- State coverage of GLP-1s for diabetes is mandatory. Yes
- In October 2025, 16 states had coverage for weight loss
- In January 2026, 13 states had coverage for weight loss
- Prior authorization: yes, required
- Changes in 2026:
- Starting January 2026, Michigan has coverage under tighter rules. The effective date is January 1, 2026
- In Pennsylvania, it ended January 2026, with effect from January 1, 2026
- Utah: The pilot's ending took effect June 30, 2026; it ended June 2026
- Wisconsin has coverage with prior authorization. It takes effect July 1, 2026
- Massachusetts no longer has coverage as of July 2026. The effective date is July 3, 2026
- Rhode Island no longer has coverage as of October 2026. The effective date is October 1, 2026
Read the full policy at KFF.
Sources: KFF, michigan.gov, pa.gov, medicaid-documents.dhhs.utah.gov.
Prior authorization checklist
- Prior authorization: yes, required
- Records: the program you tried for diet and activity, your measured height and weight, plus weight-related conditions.
- Who files it: Your prescriber, not you, sends the prior authorization.
Source: KFF.
The appeal step, if you are denied
| Denial reason | What to send or ask |
|---|---|
| Criteria not met | Ask your prescriber to send another request with your measured BMI and every weight-related condition from your chart. |
| The drug is not on the plan's list | Ask the plan for its preferred GLP-1 instead, and request a formulary exception. |
- Get the denial notice from your Medicaid plan because it names the rule that was not met.
- Your prescriber can resubmit the prior authorization with chart notes included.
- If the plan still denies coverage, you can request a state fair hearing.
State and plan differences
| 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.
If coverage says no: other routes
Sources: pricinginfo.lilly.com, mounjaro.lilly.com, GoodRx, zepbound.lilly.com.