Medicaid GLP-1 Coverage

Step therapy may be required — you may need to try a lower-cost medication first.

• •Coverage varies by state; check your state's Medicaid formulary.
• •Wegovy, Ozempic, and Mounjaro are covered in many states.
• •Zepbound is not widely covered; check your state's policy.
• •Foundayo is under review and may be added in future updates.

1. 1.Contact your state Medicaid office to confirm GLP-1 coverage in your state.
2. 2.Submit PA request with a letter from your provider and BMI documentation.
3. 3.Use the state's Medicaid portal to track PA status and submit documents.

1. 1.Appeal within 30 days of denial with updated clinical notes.
2. 2.Request a fair hearing if coverage is denied due to formulary exclusion.
3. 3.Include evidence of treatment failure with lifestyle changes and comorbidities.

• GLP-1 Medications Covered by Medicare in 2026: Complete Guide
• Best GLP-1 Without Insurance in 2026: Every Option Ranked by Cost
• Insurance Stopped Covering Your GLP-1 in 2026: What to Do Next