Quick answer: does Medicaid cover Ozempic? Yes, for type 2 diabetes, in every state. Federal law requires Medicaid to cover drugs approved for diabetes, though most states add prior authorization or preferred-drug rules.[1] For weight loss, it depends on the state, and coverage usually runs through Wegovy or Zepbound rather than Ozempic. KFF counted 13 state Medicaid programs covering GLP-1s for obesity as of January 2026.[1]
Prices and program terms checked October 2026. They change often; confirm with the manufacturer or your plan.
Ozempic contains semaglutide and is approved for adults with type 2 diabetes, including to lower heart and kidney risks in that group.[2] The same drug at higher doses is sold as Wegovy for weight management.[10]
Medicaid coverage for type 2 diabetes
Medicaid programs can choose to exclude some drug categories, including drugs used for weight loss, but they must cover drugs approved for treating diabetes.[1] Ozempic falls into that required group.
Each state, or its managed care plans, still decides how to cover it:
- Preferred drug lists (PDLs). Many states list one or more GLP-1s as “preferred” and others as “non-preferred.” A non-preferred drug usually needs extra paperwork.
- Prior authorization. States often ask for proof of type 2 diabetes, such as an A1C result.
- Step therapy. Some states require metformin first unless it is unsafe or did not work.
Because federal law limits Medicaid cost sharing to nominal amounts, covered prescriptions cost little or nothing.[6]
Medicaid coverage for weight loss
Weight-loss drugs are an optional Medicaid benefit, and states can exclude them.[3] In November 2024, CMS proposed requiring Medicaid to cover obesity drugs, but it did not finalize that rule in April 2025.[4] Coverage remains a state choice.
How many states cover GLP-1s for obesity
KFF’s January 2026 count:[1]
| Status | States |
|---|---|
| Cover GLP-1s for obesity (fee-for-service) | 13 states |
| Ended coverage after October 2025 | California, New Hampshire, Pennsylvania, South Carolina |
| Dropped then restored | North Carolina (dropped October 2025, restored December 2025) |
| Time-limited | Utah (funding limited to fiscal year 2026) |
Cost was the main reason states gave for their decisions, and few states said they were considering expanding coverage.[1] KFF’s report does not list all 13 states in text, so check with your own state.
What coverage criteria look like
States that cover obesity drugs usually set strict rules. Michigan’s Medicaid criteria, as published by one of its plans, show how tight these can be:[8]
- Adults need a BMI of 30 or higher, or 27 to 29.9 with high blood pressure, heart disease, diabetes, high cholesterol or sleep apnea.
- GLP-1s such as Wegovy and Zepbound are non-preferred. Patients must first try, or be unable to take, all five types of older preferred weight-loss drugs, including phentermine and orlistat.
- To renew, adults must keep off at least 5% of their starting weight.
The BALANCE model: a new route for states
CMS’s BALANCE model is a voluntary program in which CMS negotiates GLP-1 prices and coverage terms with manufacturers on behalf of state Medicaid programs.[5] Key points:
- Drugs included: all forms of Ozempic, Wegovy, Rybelsus and Mounjaro, the Zepbound KwikPen and Foundayo, for current uses and for weight management.[5]
- Timing: states can begin coverage on a rolling basis from May 1, 2026 through January 1, 2027. State applications were due July 31, 2026.[6]
- Extras: Medicaid enrollees get a manufacturer-provided lifestyle support program at no cost.[5]
- Pricing: the November 2025 agreements with Novo Nordisk and Eli Lilly said state Medicaid programs would have access to the same $245 prices set for Medicare. Medicaid’s net price under BALANCE is confidential.[7][6]
Participation is voluntary for states, so BALANCE does not by itself mean your state covers GLP-1s for weight loss.[5]
People with both Medicare and Medicaid
If you have both (dual eligibility), your prescription drugs, including Ozempic for diabetes, are usually covered through Medicare Part D rather than Medicaid. Drugs that Part D excludes, such as weight-loss drugs, may still fall to your state Medicaid program; the Michigan criteria above, for example, come from a plan for people with both.[8] See does Medicare cover Ozempic for how Part D and the $50 Medicare GLP-1 Bridge work.
How to check your state’s coverage
- Find your state’s preferred drug list. Search your state Medicaid agency’s website for “preferred drug list” and “GLP-1.”
- Call your managed care plan. If you are in a Medicaid health plan, the member services number on your card can tell you whether Ozempic or Wegovy is covered and what prior authorization requires.
- Ask about BALANCE. Ask whether your state joined the BALANCE model and when coverage starts.
- Bring documentation. For diabetes, your A1C or glucose results. For weight loss, your BMI history, related conditions and past treatments.
Questions to ask your state or plan
- Is Ozempic on the preferred drug list for type 2 diabetes, or do I need to try another GLP-1 first?
- What lab results or treatment history does prior authorization require?
- Does the state cover any GLP-1 for weight loss, and if so, which drugs and at what BMI?
- Has the state joined the BALANCE model, and when does that coverage start?
- What is my copay for a one-month supply?
Medicaid rules can change mid-year when state budgets change, as several 2025 cutbacks showed.[1] If your coverage is ending, ask for the exact date and whether existing approvals will be honored until then.
If Medicaid doesn’t cover it
You cannot use Novo Nordisk’s savings offer while enrolled in Medicaid.[11] Novo Nordisk’s Patient Assistance Program also requires a Medicaid denial letter if your income falls within your state’s Medicaid limits.[9]
If you have type 2 diabetes and Medicaid denies Ozempic, ask your prescriber to appeal with your lab results and treatment history. For other options, see how to get Wegovy for free, how to qualify for Ozempic and does insurance cover Ozempic.
