Data notes
Each month, one to three findings from the official drug-price and coverage data we keep: one sentence, a chart and the CSV. Free to use with credit.
October 2026
Of 18 state Medicaid programs we checked against their own documents, 11 do not cover GLP-1 drugs for weight loss alone; California, Pennsylvania and Rhode Island ended that coverage in 2026, and Michigan cut it back.
Only 3 (North Carolina, Tennessee and Virginia) have a prior-authorization path for weight management. Each state's status comes from its own Medicaid document (bulletin, drug list, provider manual or prior-authorization form), quoted word for word on the state's page. States we have not been able to check are not counted.
| State | Coverage for weight loss | Since | State document |
|---|---|---|---|
| Arizona AHCCCS | Not covered for weight loss alone | — | AHCCCS Fee-For-Service Provider Manual, Chapter 12 (Pharmacy)1 |
| California Medi-Cal Rx | Not covered for weight loss alone Coverage ended in 2026 | Jan 1, 2026 | Medi-Cal Rx alert, October 21, 20252 |
| Colorado Health First Colorado | Not covered for weight loss alone | — | HCPF Pharmacy Billing Manual, Restricted Products3 |
| Maryland Maryland Medicaid | Not covered for weight loss alone | — | Transmittal PT 35-25, September 13, 20244 |
| New Jersey NJ FamilyCare | Not covered for weight loss alone | — | NJ Department of Human Services memo to the Legislature (SFY 2026)5 |
| New Mexico New Mexico Medicaid | Not covered for weight loss alone | — | New Mexico Health Care Authority web page, Weight Reduction Medications6 |
| Pennsylvania Medical Assistance | Not covered for weight loss alone Coverage ended in 2026 | Jan 1, 2026 | Medical Assistance Bulletin, November 24, 20257 |
| Rhode Island Rhode Island Medicaid | Not covered for weight loss alone Coverage ended in 2026 | Oct 1, 2026 | EOHHS memo, August 5, 20268 |
| Vermont Vermont Medicaid | Not covered for weight loss alone | — | DVHA Preferred Drug List, updated 10/02/20269 |
| Washington Apple Health | Not covered for weight loss alone | Feb 1, 2026 | HCA medical policy 61.25.20.AA-4, effective 2/1/202610 |
| West Virginia West Virginia Medicaid | Not covered for weight loss alone | — | BMS prior authorization criteria, Zepbound (effective 7/1/2025)11 |
| New York NYRx (Medicaid Pharmacy Program) | Criteria listed only for non-obesity uses | — | NYRx Preferred Drug Program list12 |
| Ohio Ohio Medicaid | Criteria listed only for non-obesity uses | — | Ohio Medicaid Unified Preferred Drug List, effective April 1, 202613 |
| Oklahoma SoonerCare | Criteria listed only for non-obesity uses | — | Oklahoma Health Care Authority prior authorization criteria, Metabolic Disorders (last modified Oct 1, 2026)14 |
| Michigan Michigan Medicaid | Covered for obesity, with added limits Coverage cut back in 2026 | Jan 1, 2026 | MDHHS letter L 25-73, December 8, 202515 |
| North Carolina NC Medicaid | Prior-authorization path for weight management | Dec 12, 2025 | NC Medicaid bulletin, December 19, 202516 |
| Tennessee TennCare | Prior-authorization path for weight management | — | TennCare prior authorization form, Weight Management Agents (revised 08/2026), on OptumRx's TennCare site17 |
| Virginia Virginia Medicaid (DMAS) | Prior-authorization path for weight management | — | DMAS service authorization form, Weight-Loss Management (effective 07/01/2026), hosted on the Virginia Medicaid Pharmacy Services portal18 |
Download the data (CSV) · Each state's page quotes its document word for word. States not listed here have not been checked yet. Coverage for other uses (for example diabetes) is a separate question.
October 2026
Medicare's 2027 negotiated price for semaglutide (Ozempic, Rybelsus, Wegovy) is $274 for a 30-day supply, 71% below its $959 list price.20
The price drug companies must make available to pharmacies for people with Medicare Part D from January 1, 2027. It is not what a patient pays; that depends on the Part D plan, and Part D caps yearly out-of-pocket costs at $2,400 in 2027.
| Drug | List price, 30 days | Medicare negotiated price, 30 days | Below list | In effect from |
|---|---|---|---|---|
| Otezla Amgen | $4,722 (2024) | $1,65019 | 65% | Jan 1, 2027 |
| Ozempic, Rybelsus, Wegovy (semaglutide) Novo Nordisk | $959 (2024) | $27420 | 71% | Jan 1, 2027 |
| Jardiance Boehringer Ingelheim | $573 (2023) | $19721 | 66% | Jan 1, 2026 |
| Eliquis Bristol Myers Squibb and Pfizer | $521 (2023) | $23122 | 56% | Jan 1, 2026 |
Download the data (CSV) · List prices are the ones in CMS's tables (wholesale acquisition cost for a 30-day supply, rounded by CMS). Negotiated prices are what drug companies must make available to pharmacies for people with Medicare Part D; they are not what a patient pays.
How to cite
Free to reuse under CC BY 4.0: credit MedCost Clear and link to this page.
MedCost Clear. "State Medicaid coverage of GLP-1 drugs for weight loss." Data as of Oct 18, 2026. https://medcostclear.com/data/
MedCost Clear. "Medicare negotiated prices vs list prices." Data as of Oct 23, 2026. https://medcostclear.com/data/
How the numbers are made
- Only official sources: CMS, Medicare.gov, FDA, state Medicaid programs, data.medicaid.gov and the drug makers' own price pages. No coupon or discount-card sites.
- We keep a dated copy of every government page or file behind a number, and our build fails if the quoted wording is not found in that copy. Makers' pages whose terms forbid copying are read by a person and the number is entered by hand with its source.
- Percentages are recomputed from CMS's numbers and match CMS's own rounding.
- More on sources and update schedule and editorial policy.
Contact
Questions about the data, or a correction: [email protected].
Official sources for this page (22)
“The following are excluded from coverage under the outpatient FFS pharmacy benefit:”
Arizona AHCCCS: AHCCCS Fee-For-Service Provider Manual, Chapter 12 (Pharmacy) · as of Oct 17, 2026“Effective January 1, 2026, Medi-Cal Rx will no longer cover the following GLP-1 drugs when used for weight loss or weight-loss indications:”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“The Health First Colorado program restricts or excludes coverage for some drug categories.”
Colorado Health First Colorado: HCPF Pharmacy Billing Manual, Restricted Products · as of Oct 18, 2026“Wegovy will not be covered when the sole indication is for chronic weight management”
Maryland Maryland Medicaid: Transmittal PT 35-25, September 13, 2024 · as of Oct 17, 2026“NJ FamilyCare already provides coverage of drugs indicated for weight loss in certain limited circumstances.”
“Some weight loss medications for treating obesity are covered under the New Mexico Medicaid Fee-for-Service program with prior authorization.”
“effective January 1, 2026, coverage will end for drugs containing a glucagon-like peptide-1 (GLP-1) receptor agonist for the treatment of overweight and obesity for Medical Assistance (MA) beneficiaries.”
Pennsylvania Medical Assistance: Medical Assistance Bulletin, November 24, 2025 · as of Oct 17, 2026“beginning October 1, 2026, Rhode Island Medicaid will no longer cover certain GLP-1 receptor agonists when they are prescribed solely for weight loss.”
Rhode Island Rhode Island Medicaid: EOHHS memo, August 5, 2026 · as of Oct 17, 2026“Drugs used for weight loss, drugs used to promote fertility, and drugs used for cosmetic purposes or hair growth are excluded from coverage under the Vermont Medicaid Pharmacy program.”
Vermont Vermont Medicaid: DVHA Preferred Drug List, updated 10/02/2026 · as of Oct 17, 2026“Semaglutide injection or tablet (Wegovy®) is not covered by Apple Health for weight loss”
Washington Apple Health: HCA medical policy 61.25.20.AA-4, effective 2/1/2026 · as of Oct 17, 2026“Agents used for the purpose of weight loss are typically a benefit exclusion and not covered by West Virginia Medicaid.”
“semaglutide (Wegovy®) LIFETIME QUANTITY LIMIT: • Two treatment attempts per lifetime • Confirm diagnosis of cardiovascular disease”
New York NYRx (Medicaid Pharmacy Program): NYRx Preferred Drug Program list · as of Oct 17, 2026“GLP-1 AGONISTS FOR NON-OBESITY INDICATIONS”
“Wegovy ® will not be approved for obese or overweight members in the absence of established CVD”
“Coverage of GLP-1 medications when prescribed solely to treat obesity, including requests for continuation, will be reduced.”
Michigan Michigan Medicaid: MDHHS letter L 25-73, December 8, 2025 · as of Oct 17, 2026“NC Medicaid coverage for GLP-1s for the treatment of obesity is being reinstated effective Dec. 12, 2025.”
North Carolina NC Medicaid: NC Medicaid bulletin, December 19, 2025 · as of Oct 17, 2026“Weight Management Agents”
“WEIGHT-LOSS MANAGEMENT”
“Otezla; Otezla XR Amgen Inc. Oral ulcers in Behçet’s Disease; Plaque psoriasis; Psoriatic arthritis $1,650 $4,722 65%”
“Ozempic; Rybelsus; Wegovy Novo Nordisk Inc. Type 2 diabetes; Type 2 diabetes and cardiovascular disease; Cardiovascular disease and obesity/ overweight $274 $959 71%”
“Jardiance Boehringer Ingelheim Diabetes; Heart failure; Chronic kidney disease $197.00 $573.00 66%”
“Eliquis Bristol Myers Squibb Prevention and treatment of blood clots $231.00 $521.00 56%”