Effective Jan. 1, 2026, coverage and criteria of GLP-1 weight-loss drugs Saxenda, Wegovy and Zepbound will become more restrictive for all Michigan Medicaid members.
Why the change?
The State of Michigan fiscal year 2026 budget made a law that required Michigan Medicaid to further restrict coverage of GLP-1 weight-loss drugs; Saxenda, Wegovy, and Zepbound.
MDHHS has issued a provider notification, L 25-73-Update of Pharmacy Drug Coverage for Treatment of Obesity., and has posted the new criteria online.
Will the state still cover GLP-1s for other conditions?
Yes. Coverage of GLP-1s approved for the treatment of Type II Diabetes (e.g., Ozempic, Mounjaro) will not change.
Criteria for Wegovy and Zepbound will be updated to include non-weight loss indications (e.g., to reduce the risk of major adverse cardiovascular events, or severe obstructive sleep apnea). Prior authorization will be required for all indications.
Please refer to the Medicaid Approved Drug List for current coverage information.
How will this impact members?
- Medicaid members who are currently approved for a GLP-1 weight-loss drug will have continued coverage through the end of their current authorization.
- Upon renewal, members will need to meet the new criteria to continue with coverage.
- New criteria will be applied to requests with dates of service on or after Jan. 1, 2026.
What other coverage options do we offer for weight loss?
- Other clinically appropriate weight-loss interventions, including Preferred Drug List (PDL) preferred anti-obesity medications will continue to be covered.
- Dietary counseling may be available with a referral.
- Pre-diabetic patients may enroll in the Diabetes prevention program.