# Does Arkansas Medicaid Cover Wegovy or Zepbound? The Three Routes That Remain By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06 Canonical page: https://glpwatchdog.org/research/arkansas-medicaid-glp1-coverage > Arkansas Medicaid pays for no drug prescribed only to lose weight, and a 2025 law mandating bariatric surgery left the drugs out. What the state does cover, with the test for each of its three Wegovy and Zepbound routes, ARHOME and PASSE differences and how to appeal. ## Key points - No Arkansas Medicaid route exists for a GLP-1 prescribed only to lose weight, including the Foundayo pill. - Act 628 of 2025 made Medicaid pay for bariatric surgery but said the program need not pay for weight-loss drugs. - Wegovy heart-risk requests need a prior heart event, a BMI of at least 27 and, for smokers, a cessation program. - Zepbound for sleep apnea needs six months of CPAP or BiPAP that still leaves an AHI of 15 or more. - ARHOME members get Medicaid through Blue Cross Blue Shield or Ambetter, so their carrier sets the drug list they follow. No. Arkansas Medicaid does not cover Wegovy, Zepbound or any other drug prescribed only for weight loss, and its prior authorization criteria, revised October 1, 2026, say so on both drugs’ pages.[1] As of November 2026 it does cover Wegovy with prior authorization for people with heart disease and a BMI of at least 27 or for the liver disease MASH, and Zepbound for moderate to severe sleep apnea after six months on CPAP.[1] > **About this article.** This page reads the Arkansas Medicaid drug criteria, provider memos and Department of Human Services pages as they stood on November 6, 2026. The criteria come from the state’s pharmacy program, which Prime Therapeutics runs. People in ARHOME or a PASSE get their drug benefit through a private plan, so their route can differ, as explained below. For why states are allowed to exclude these drugs, see [why Medicaid treats Ozempic and Wegovy differently](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy). ## Is there any Arkansas Medicaid route for weight loss alone? No, and there is no exception process for weight loss alone. The Wegovy page of the state’s criteria opens with a note ruling out drugs used only to lose weight, and the Zepbound page repeats it.[1] Each lists “requested for weight loss only” as a reason to deny.[1] When Wegovy tablets were added in May 2026, the provider memo repeated that the pharmacy program “does not cover medications for weight loss.”[2] The state’s quarterly newsletters, most recently in October 2026, give the newest GLP-1 pill, Foundayo, a one-line verdict: weight loss is not covered.[3] Under federal law, every state may leave weight-loss drugs out of Medicaid.[10] Arkansas lawmakers had a chance to change that in 2025 and chose not to. Act 628 requires Medicaid to pay for bariatric surgery and the care around it, then says in subsection (c) that nothing in it obliges the program to pay for glucose-lowering injections or other weight-loss prescriptions.[4] So an Arkansan with severe obesity can get surgery covered but not a GLP-1 for the same diagnosis. ## When does Arkansas Medicaid cover Wegovy? Wegovy has two covered uses in Arkansas, both drawn from its FDA label: cutting the odds of a heart attack, stroke or cardiovascular death for adults who already have heart disease, and treating MASH with moderate to advanced liver scarring.[8][1] The state’s tests go further than the label in several places. *Arkansas Medicaid prior authorization criteria for Wegovy and Zepbound, revised October 1, 2026* | Use | Drug | Main requirements | First approval | | --- | --- | --- | --- | | Weight loss alone | Any GLP-1 | Not covered | None | | Heart-risk reduction | Wegovy pen or tablet | Prior heart attack, stent or bypass, stroke, or symptomatic peripheral artery disease, plus a BMI of at least 27; a diet and activity plan; not a current smoker, or enrolled in a cessation program | Not stated; renewal needs 75% adherence and better heart and body measures | | MASH, fibrosis F2 to F3 | Wegovy pen only | Biopsy, or one blood test plus one imaging test; endocrinologist, gastroenterologist or hepatologist involved; BMI ≥ 27; other causes ruled out; people with type 2 diabetes must use a diabetes GLP-1 instead | 6 months; renewals up to 12 months | | Moderate to severe sleep apnea | Zepbound 10 mg and 15 mg | AHI ≥ 15 on a sleep study; BMI ≥ 30 plus heart disease, type 2 diabetes, high cholesterol or high blood pressure; 6 months in a weight program; 6 months of CPAP or BiPAP use with AHI still ≥ 15 | 6 months | The smoking rule on the heart route catches people by surprise. A current smoker must have started a cessation program before Wegovy can be approved.[1] The prescriber also has to send chart notes, an HbA1c and lipid panel, baseline weight and waist size, blood pressure and heart rate, and an attestation that the patient was counseled on diet and activity.[1] Wegovy tablets follow the heart-risk criteria only, since the MASH section is labeled for the injection.[1][2] The MASH route has a diabetes twist. A person with both type 2 diabetes and MASH is sent to a GLP-1 approved for diabetes rather than Wegovy.[1] For background on what the liver trial showed, see our guide to [GLP-1s and MASH](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash). ## Does Arkansas Medicaid cover Zepbound for sleep apnea? Yes, but the bar is high. The label covers moderate to severe sleep apnea in adults with obesity.[9] Arkansas adds a second condition tied to weight, half a year in a structured weight program, and at least six months of documented CPAP or BiPAP use that has not brought the apnea-hypopnea index below 15.[1] In practice that means a person who tolerates CPAP well enough to use it every night, yet still has moderate apnea on it. Someone who could not tolerate CPAP has no stated route, because skipping nightly CPAP is one of the listed grounds for denial.[1] The criteria page is titled for the 10 mg and 15 mg strengths, the sleep apnea maintenance doses on the label, which starts everyone at 2.5 mg.[1][9] The page does not say how the starting strengths are handled, so ask the pharmacy help desk before the first fill. Our guide to [Zepbound for sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) explains the trial results behind this use. ## Does Arkansas Medicaid cover Ozempic or Mounjaro for diabetes? Yes, but they are not the drugs the state prefers. Trulicity and brand-name Victoza are the preferred GLP-1s for diabetes. Ozempic, Rybelsus, Mounjaro and generic liraglutide are non-preferred and need prior authorization.[1] A preferred drug passes the automatic check when the pharmacy record shows a type 2 diabetes diagnosis plus a metformin claim or an HbA1c of 9 or higher in the past 186 days, or a diagnosis of atherosclerotic heart disease.[1] None of these is approved for weight loss in Arkansas Medicaid. The October 2026 newsletter lists Mounjaro among drugs whose prior authorization criteria the state’s drug review board would take up on October 21, 2026; as of November 6, 2026 the posted criteria still list it only as a non-preferred diabetes drug.[3][1] ## Does it matter if you are in ARHOME or a PASSE? It can. ARHOME, the program for many adults who qualify through Medicaid expansion, uses Medicaid money to buy private coverage from Blue Cross Blue Shield or Ambetter.[6] Those members are still on Medicaid, but the carrier on their card handles their benefits, so they should ask that carrier which drug list and criteria apply to them. PASSE plans, which serve people with significant behavioral health needs or developmental disabilities, include pharmacy, and the state tells prescribers to send PASSE drug questions to the member’s PASSE.[7][2] The criteria in this article govern the state’s own pharmacy program. ## What about children and teens? Wegovy’s label includes obesity treatment from age 12, but Arkansas covers no weight-loss use at any age, and its criteria have no pediatric obesity page for a GLP-1.[8][1] Federal law does require Medicaid to provide necessary treatment found through child health screening for people under 21, even when the state plan does not cover it.[11] We found no Arkansas document that applies that rule to GLP-1s. A family that gets a flat denial for a teen can ask in writing for a medical necessity review under EPSDT, the federal child-health benefit. ## How do you request approval or appeal a denial in Arkansas? - **Requests.** Prescribers submit through CoverMyMeds or by fax to the state pharmacy unit at 800-424-5851, the number printed on both the Wegovy and Zepbound pages. The Prime help desk is 800-424-7895.[1] - **Paperwork.** Each route lists what to send: chart notes, labs, BMI and weight, and route-specific proof such as a sleep study with the CPAP usage report or the fibrosis results.[1] - **Appeals.** For a denied Medicaid service, the state says to send a letter asking for an administrative hearing, and warns that a late request will be denied.[5] Its appeals page gives no day count for this kind of denial, so use the deadline printed on your notice and file promptly. An appeal works best when the denial concerns a covered use, such as a missing CPAP report. It has nothing to work with when the request rests on weight alone. Our walkthrough of [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what makes a strong file, and the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker) shows how Arkansas compares with other states. ## What are the options without Medicaid coverage? Paying cash is the main one. Lilly’s savings card for insured patients excludes anyone enrolled in Medicaid, so it will not lower the price.[12] Self-pay prices in the figures we track are $349 a month for most Wegovy pen doses from Novo Nordisk, and from $299 at the starting dose, $399 at 5 mg and $449 at higher doses refilled on time for Lilly’s Zepbound.[12][13] Read each offer’s terms on government-program enrollment before you sign up. Our list of the [cheapest GLP-1 routes without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them, and the [Arkansas page](https://glpwatchdog.org/states/arkansas) lists sellers that ship to the state. ## Frequently asked questions ### Will Arkansas Medicaid pay for Wegovy to lose weight? No. As of November 2026, Arkansas Medicaid does not cover any drug prescribed only for weight loss. Wegovy can be approved with prior authorization for an adult who has had a heart attack, stroke or qualifying artery disease and has a BMI of at least 27, or for MASH with stage F2 to F3 liver fibrosis. ### Does Arkansas Medicaid cover Zepbound? Only for moderate to severe obstructive sleep apnea. The criteria require an apnea-hypopnea index of at least 15, a BMI of at least 30 plus one related condition such as high blood pressure, half a year in a weight management program and at least six months of CPAP or BiPAP use. Approvals last six months. ### Does Arkansas Medicaid cover Ozempic? Yes, for type 2 diabetes, with prior authorization. Ozempic is non-preferred; Trulicity and brand-name Victoza are the preferred GLP-1s. Ozempic is not covered when it is prescribed for weight loss. ### Does ARHOME cover Wegovy or Zepbound? ARHOME members get Medicaid coverage through a private carrier, Blue Cross Blue Shield or Ambetter, so the carrier on the card is the one to ask about its drug list and criteria. Arkansas Medicaid itself does not cover weight-loss drugs. ### Did Arkansas pass a law requiring Medicaid to cover weight-loss drugs? No. Act 628 of 2025 requires Arkansas Medicaid to pay for bariatric surgery and related care for severe obesity, and it says the program does not have to pay for weight-loss medicines, injectable or otherwise. ## References 1. Arkansas Medicaid Prescription Drug Program; Prime Therapeutics State Government Solutions Arkansas Medicaid Prior Authorization Criteria (revised October 1, 2026): Wegovy, Zepbound OSA and antidiabetic agent pages. ar.primetherapeutics.com. 2026. https://ar.primetherapeutics.com/documents/d/arkansas/pacriteria 2. Arkansas Medicaid Prescription Drug Program Prior Authorization Edits and Preferred Drug List Updates: provider memo dated May 13, 2026. ar.primetherapeutics.com. 2026. https://ar.primetherapeutics.com/documents/d/arkansas/ar-medicaid-april-2026-dur-provider-memo 3. Arkansas Medicaid Prescription Drug Program Arkansas Medicaid quarterly newsletter, October 2026. ar.primetherapeutics.com. 2026. https://ar.primetherapeutics.com/documents/d/arkansas/arkansas-medicaid-quarterly-newsletter-october-2026 4. Arkansas General Assembly Act 628 of 2025 (HB 1424): An Act to Mandate Coverage for Severe Obesity Treatments. arkleg.state.ar.us. 2025. https://arkleg.state.ar.us/Acts/FTPDocument?path=%2FACTS%2F2025R%2FPublic%2F&file=628.pdf&ddBienniumSession=2025%2F2025R 5. Arkansas Department of Human Services File an Appeal. humanservices.arkansas.gov. 2026. https://humanservices.arkansas.gov/contact-us/file-an-appeal/ 6. Arkansas Department of Human Services ARHOME (Arkansas Health and Opportunity for Me). humanservices.arkansas.gov. 2026. https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/arhome/ 7. Arkansas Department of Human Services PASSE (Provider-led Arkansas Shared Savings Entity). humanservices.arkansas.gov. 2026. https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/medicaid/passe/ 8. Novo Nordisk WEGOVY (semaglutide) injection and tablets: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b 9. Eli Lilly and Company ZEPBOUND (tirzepatide) injection: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b 10. United States Code 42 U.S.C. §1396r-8: Payment for covered outpatient drugs (Social Security Act §1927). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396r-8 11. United States Code 42 U.S.C. §1396d: Definitions, including early and periodic screening, diagnostic, and treatment services (subsection r). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396d 12. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 13. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html --- Cite as: GLP Watchdog, Nora Bissett, "Does Arkansas Medicaid Cover Wegovy or Zepbound? The Three Routes That Remain", published 2026-11-06. https://glpwatchdog.org/research/arkansas-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/arkansas-medicaid-glp1-coverage Medical disclaimer: Nothing here is medical advice. We report on this subject; we do not treat anyone. Whether to begin a medication, supplement, or treatment, whether to adjust it, and whether to stop are questions for a clinician licensed to answer them, who knows your history.