Insurance / Medicaid / Pennsylvania
Does Pennsylvania Medicaid cover GLP-1 drugs for weight loss?
Medical Assistance, from the state's own document. Weight-loss use only.
Short answer
Not covered for weight loss aloneIn effect from Jan 1, 2026
Since January 1, 2026, Medical Assistance no longer covers GLP-1 drugs for overweight and obesity.1
Source: Medical Assistance Bulletin, November 24, 2025 · checked Oct 17, 2026
What the state's document says
Word for word from the document, as archived on Oct 17, 2026.
“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.”
Federal background
- Each state runs its own Medicaid program within federal guidelines, so eligibility and benefits can vary widely from state to state.23
- Under CMS's voluntary BALANCE model, CMS negotiates GLP-1 prices and coverage terms with manufacturers on behalf of state Medicaid agencies that join.4
- States could choose a start date between May 1, 2026 and January 1, 2027; states that have not joined by January 1, 2027 cannot join except at CMS's discretion.56 CMS's BALANCE page, as we last checked it, does not list participating states, so we do not say whether Pennsylvania has joined.
Self-pay prices and government insurance
The makers list self-pay prices for each strength; see every self-pay price, cheapest first. The official wording about government insurance differs between pages; read the offer terms before relying on a self-pay price.78
Next step
Ask Medical Assistance or your Medicaid plan whether a specific drug is covered for you. The document above is what we checked; your plan may have newer rules.
Which drug, which dose, and whether to start, stop or switch are medical decisions. Ask your doctor or pharmacist.
Other states we have checked
- Arizona · Not covered for weight loss alone
- California · Not covered for weight loss alone
- Maryland · Not covered for weight loss alone
- Michigan · Covered for obesity, with added limits
- New Jersey · Not covered for weight loss alone
- New York · Criteria listed only for non-obesity uses
- North Carolina · Prior-authorization path for weight management
- Ohio · Criteria listed only for non-obesity uses
- Rhode Island · Not covered for weight loss alone
- Tennessee · Prior-authorization path for weight management
- Vermont · Not covered for weight loss alone
- Virginia · Prior-authorization path for weight management
- Washington · Not covered for weight loss alone
Official sources for this page (8)
“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“Each state runs its own Medicaid program according to certain federal guidelines.”
NovoCare: Medicaid · as of Oct 17, 2026“As a result, Medicaid eligibility and benefits can vary widely from state to state.”
NovoCare: Medicaid · as of Oct 17, 2026“As part of this voluntary model, CMS will negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.”
CMS Innovation Center: BALANCE Model · as of Oct 17, 2026“States may choose to start participating in BALANCE starting on a date of their choosing between May 1, 2026, and January 1, 2027.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“States that do not join the model by January 1, 2027, will not be allowed to participate in the model except at CMS discretion.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“Self-pay pricing varies by dose. Eligibility and restrictions apply. Government beneficiaries excluded. One month is defined as one bottle containing 30 tablets. Novo Nordisk reserves the right to modify or cancel this offer at any time. See full Terms and Conditions.”
TrumpRx.gov: Wegovy Tablet listing · as of Oct 17, 2026“Patients who use this savings offer and are enrolled in government, state, or federally-funded medical or prescription benefit programs are able to pay the self-pay price for their prescription. This offer operates outside of any third-party insurance. The money spent and discounts on your prescription will not count toward your deductible or out-of-pocket requirements and cannot be submitted for reimbursement to your insurer.”
NovoCare: Wegovy savings offer · as of Oct 17, 2026