Milly Gaines
Medicaid is a federal-state program that provides health insurance to eligible low-income individuals and families in the US. While Medicaid covers some weight-loss programs, obesity screenings, and bariatric surgery, its coverage of weight-loss medications varies by state. Some state Medicaid programs cover weight-loss drugs like Ozempic, Wegovy, and Saxenda, especially if used for treating type 2 diabetes. However, certain states mandate specific requirements, such as a doctor's letter and exercise program participation, for coverage of weight-loss medications.
| Characteristics | Values |
|---|---|
| Does Medicaid cover weight-loss drugs? | Medicaid may cover weight-loss drugs, but it depends on the state and the specific drug. |
| Drugs covered by Medicaid | Saxenda (liraglutide), Wegovy (semaglutide), Zepbound (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide), Victoza (liraglutide), and Mounjaro (tirzepatide). |
| Requirements for coverage | A letter from a doctor stating that the patient's weight is disabling and life-threatening, participation in an exercise program, prior authorization, and BMI requirements. |
| Number of states offering weight-loss drug coverage | As of 2024, 16 states offer weight-loss drug coverage, while 34 states and the District of Columbia do not. |
| States that offer coverage | Texas, Louisiana, Illinois, Massachusetts, New Mexico, Utah, and Vermont. |
| Medicaid coverage for weight-loss surgery | Medicaid may cover weight-loss surgery, but it must be performed at a Bariatric Center for Excellence. |
| Other services covered by Medicaid for weight loss | Obesity screenings, bariatric surgery, gym memberships, nutritional and psychological services, and prescription drugs that promote weight loss. |
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What You'll Learn
Does Medicaid cover Ozempic?
Medicaid is a government-run health insurance program that provides medical assistance to eligible low-income individuals and families, pregnant women, and people with certain disabilities. Prescription coverage for Medicaid plans is often determined by individual states.
Ozempic (semaglutide) is a medication that is FDA-approved for Type 2 diabetes and for reducing the likelihood of significant cardiovascular events in adults with Type 2 diabetes and a pre-existing heart condition. It is also prescribed off-label for weight loss, as it can affect the regions of the brain that control hunger and fullness. However, weight loss is not an FDA-approved use of Ozempic.
Medicaid may cover Ozempic for the treatment of Type 2 diabetes, depending on the state. Some states may require prior authorization or have other restrictions in place. For example, North Carolina lists Ozempic as a preferred medication, while other states list it as non-preferred. Coverage for weight loss medications varies by state Medicaid program, and many programs require prior authorizations before covering weight-loss medications. If Ozempic is not listed on a state's Medicaid formulary, it is unlikely to be covered.
If you have Medicaid and are interested in taking Ozempic, you can check your state's preferred drug list online or by calling the phone number on your insurance card. You can also contact your state agency to find out whether coverage may be possible.
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Does Medicaid cover Wegovy?
Medicaid coverage varies depending on the state in which the enrollee lives and the specific Medicaid plan they are enrolled in. While some benefits are mandatory and must be provided by each state's Medicaid program, others, such as prescription medication coverage, are optional.
Medicaid may cover Wegovy (semaglutide), a prescription medicine used with a reduced-calorie diet and increased physical activity to help manage weight and reduce the risk of major cardiovascular events in adults with known heart disease and obesity or overweight. However, coverage depends on the state's program and the enrollee's specific Medicaid plan. As of March 2024, Wegovy must be covered for preventing heart attacks or strokes in adults with cardiovascular disease.
As of July 2023, nine states—California, Connecticut, Delaware, Michigan, Minnesota, Pennsylvania, Rhode Island, Virginia, and Wisconsin—have added Wegovy to their Medicaid preferred drug lists, allowing patients to receive coverage without first trying less expensive drugs. Other states may offer limited coverage, requiring beneficiaries to pay out of pocket for a portion of the cost.
Medicaid coverage for weight-loss medications and treatments can vary, and some states may not cover Wegovy at all. For example, as of January 1, 2025, adults in Massachusetts can no longer get Wegovy covered through Medicaid for weight management. Adolescents aged 12 to 17 can still get coverage for Wegovy, and adults with an established heart condition and either obesity or overweight may also be eligible for coverage if prescribed the medication to reduce the risk of major cardiovascular events.
The cost of Wegovy without insurance is approximately $1,350 per month, but the retail price can vary depending on the pharmacy. The typical cash price for those without insurance is $1,811.35 for four weekly injections.
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Does Medicaid cover Saxenda?
Medicaid is a joint federal and state program that provides health insurance coverage to eligible low-income individuals and families in the U.S. Some benefits are mandatory and must be provided by each state’s Medicaid program, while other benefits, such as prescription medication coverage, are optional.
Medicaid covers some weight-loss programs, obesity screenings, bariatric surgery, and other services to help beneficiaries lose weight. Weight-loss medications can cost more than $1,000 a month without insurance. Medicaid may cover Saxenda (liraglutide), a prescription medicine used for adults with excess weight (BMI ≥27) who also have weight-related medical problems or obesity (BMI ≥30). Saxenda is also used for children aged 12-17 years with a body weight above 132 pounds (60 kg) and obesity. However, it should be noted that Saxenda is not recommended for people who also take liraglutide or other medicines called glucagon-like peptide 1 receptor agonists (GLP‑1 receptor agonists).
As of July 1, 2024, 12 states reported covering GLP-1s, with 11 of those states covering all three GLP-1s currently approved for the treatment of obesity (Saxenda, Wegovy, or Zepbound). However, it's important to note that each state decides for itself what prescription drugs to cover through Medicaid. Therefore, it's recommended to contact your state’s Medicaid office to determine if Saxenda is covered in your state.
While Medicaid may cover Saxenda in some states, it's important to be aware of the potential side effects associated with the medication. Saxenda can cause an increased heart rate, and serious allergic reactions, including swelling of the face, lips, tongue, or throat, fainting, dizziness, a rapid heartbeat, problems breathing or swallowing, and severe rashes or itching. It has also been linked to kidney problems, including kidney failure, which can result from dehydration caused by nausea, vomiting, or diarrhea. Additionally, studies in rats and mice have shown that Saxenda and similar medications can cause thyroid tumors, including thyroid cancer.
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Does Medicaid cover weight-loss surgery?
Medicaid may cover weight-loss surgery, but eligibility and coverage details vary by state. State Medicaid programs may cover procedures such as gastric bypass, adjustable gastric banding, laparoscopic sleeve gastrectomy, and other weight-loss surgeries if they are considered medically necessary.
Each state has a set of benefits that its Medicaid program is required to offer, known as mandatory Medicaid benefits. Once this required coverage is met, states have flexibility in offering other benefits, known as optional Medicaid benefits. While weight-loss drugs are not a mandatory benefit, many state Medicaid programs cover weight-loss pills and surgeries among their optional benefits.
According to the 2022 Obesity Across America report, 48 states offer some level of Medicaid coverage for bariatric surgery. This often includes coverage for surgical procedures like gastric bypass and adjustable gastric banding. Most states provide some type of bariatric surgery coverage through their Medicaid programs, but specific requirements must be met to obtain coverage, and only certain types of surgeries may be covered. For example, North Carolina covers weight-loss surgeries if you meet certain criteria, but does not cover operations like gastric wrapping or open sleeve gastrectomy.
Medicaid will not cover cosmetic surgery to remove excess skin or folds that may result from weight loss surgery. However, Medicaid may cover preoperative evaluations, hospital stays, and postoperative care, as well as obesity-related preventive screening and counseling services.
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Does Medicaid cover weight-loss medication in my state?
Medicaid is a joint federal and state program that provides health insurance coverage to eligible low-income individuals and families in the US. Some benefits are mandatory and must be provided by each state's Medicaid program, while others, such as prescription medication coverage, are optional.
Medicaid covers some weight-loss programs, obesity screenings, bariatric surgery, and other services to help beneficiaries lose weight. Weight-loss medication coverage depends on the state running the program. States can decide whether to cover weight-loss drugs under Medicaid, and they can also select which medications will be covered. For example, a state may not cover Wegovy, but it may cover Saxenda (liraglutide), which is FDA-approved for chronic weight management.
As of July 1, 2024, 12 states reported covering GLP-1s, with 11 of those states covering all three GLP-1s currently approved for the treatment of obesity: Saxenda, Wegovy, or Zepbound. As of January 1, 2025, adults in Massachusetts can no longer get Wegovy covered through Medicaid for weight management, but adolescents aged 12 to 17 can still get coverage.
Medicaid programs must cover nearly all of a participating manufacturer's FDA-approved drugs for medically accepted indications. However, weight-loss drugs are included in a small group of drugs that can be excluded from coverage. Obesity is often considered a lifestyle issue by insurance plans rather than a medical condition.
If your medication is not listed on your program's formulary, you can contact your state agency to find out whether it may still be possible to get coverage. Sometimes, state Medicaid programs will cover medications not listed on their formularies, but they may assign higher costs.
In addition to weight-loss medication, some state Medicaid programs may also cover gym memberships to help beneficiaries lose weight and stay healthy.
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Frequently asked questions
It depends on the state. Medicaid covers some weight loss programs, obesity screenings, bariatric surgery, and other services to help beneficiaries lose weight.
Medicaid may cover Wegovy, Saxenda, and Zepbound. Medicaid programs must cover nearly all FDA-approved drugs, but weight-loss drugs are excluded from this.
Medicaid covers bariatric surgery, gastric bypass surgery, and lap band surgery for beneficiaries with a BMI of 35 or higher who have at least one comorbidity and have previously undergone treatment for obesity.
Medicaid covers obesity screenings, nutritional and psychological services, and gym memberships to help beneficiaries lose weight.
Medicaid covers prescription drugs that promote weight loss, such as Ozempic, Rybelsus, and Victoza.
