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Even in states that do cover GLP-1s for weight loss, Medicaid beneficiaries typically must meet additional requirements, which may include: A Body Mass Index (BMI) above a certain threshold (often 30+, or 27+ with a related condition) A documented diagnosis of obesity or overweight with a comorbidity Prior authorization approval Proof that lifestyle interventions have been tried and failed State-by-State: How Medicaid GLP-1 Coverage Varies Coverage falls into three broad categories depending on your state: Full Coverage (Diabetes + Obesity) A smaller group of states cover GLP-1s like Ozempic and Wegovy for both Type 2 diabetes and obesity
Overweight with comorbidities In patients who are overweight and have at least one comorbidity (diabetes, high blood pressure, sleep apnea, etc.)
Antipsychotic weight gain What sets the GLP-1 RAs apart from alternatives for antipsychotic-induced weight gain (like metformin and olanzapine/samidorphan) is their ability to reverse weight gain after it has already started to get out of control
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