# Does Medi-Cal Cover Wegovy or Zepbound? Not for Adult Weight Loss Since January 2026 By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-07 Canonical page: https://glpwatchdog.org/research/does-medi-cal-cover-wegovy-and-zepbound > California's Medicaid program dropped GLP-1s for adult weight loss on January 1, 2026, at any BMI. Wegovy for MASH needs only a diagnosis code; heart and sleep apnea requests go through prior authorization. Under-21 reviews, hearing deadlines and cash options. ## Key points - Adults on Medi-Cal lost weight-loss coverage of every GLP-1 on January 1, 2026, and BMI makes no difference. - Wegovy pens for noncirrhotic MASH have been payable without prior authorization since April 1, 2026, when the claim carries code K76.0 or K75.8. - Zepbound is off the drug list and rejects at the pharmacy; a prior authorization can be filed for sleep apnea, and Wegovy requests for heart disease follow the same path. - Members under 21 can still be reviewed for weight-loss use under the federal children's benefit. - Members have 90 days to request a State Hearing on a denial; asking to stay on the drug during the dispute generally has to happen within 10 days. No. As of November 2026, Medi-Cal no longer pays for Wegovy or Zepbound as weight-loss treatment in anyone 21 or older, at any BMI, and approvals already in place expired on December 31, 2025.[1][2][3] Coverage remains for narrower uses: Wegovy for noncirrhotic MASH with a diagnosis code, and case-by-case review of Wegovy in cardiovascular disease, Zepbound in sleep apnea, and weight-loss treatment for members under 21.[1][2] > **About this article.** Written from the Medi-Cal Rx Contract Drugs List dated November 1, 2026, its provider alert and two FAQs last updated April 6, 2026, its member flyer and letter, California’s budget summary, and the FDA labels on DailyMed, read on November 1, 2026 and rechecked on November 7, 2026. For the federal rules behind every state’s decision, read our guide to [Medicaid coverage of Ozempic and Wegovy](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy). ## Does Medi-Cal cover Wegovy or Zepbound for weight loss? Not for adults. The November 2026 drug list calls GLP-1s for weight loss a non-benefit, and the exception it names is for members younger than 21.[1] The rule applies to every Medi-Cal member, and the state’s letter to enrollees said so directly.[6] BMI and past approval make no difference: the provider FAQ says coverage is gone regardless of BMI and that continuing care does not apply to weight-loss use.[3] What happens at the pharmacy depends on the drug and the reason for the prescription. Medi-Cal Rx runs three separate routes, shown below. *Medi-Cal Rx GLP-1 coverage as of November 2026* | Drug and use | Medi-Cal Rx position | What it takes | | --- | --- | --- | | Wegovy, Zepbound or Saxenda for weight loss, age 21 or older | Not covered | No route through prior authorization | | Any GLP-1 for weight loss, under age 21 | Reviewed case by case | Prior authorization showing medical necessity | | Wegovy pens for noncirrhotic MASH | Covered since April 1, 2026 | Claim must carry K76.0 and/or K75.8; no prior authorization | | Wegovy for cardiovascular disease | Reviewed case by case | Prior authorization showing medical necessity | | Zepbound for obstructive sleep apnea | Reviewed case by case | Prior authorization showing medical necessity | | The seven diabetes GLP-1s (Ozempic, Rybelsus, Mounjaro, Trulicity, Victoza, Bydureon, Byetta), diabetes use | Covered | Diabetes diagnosis code on the claim | | Saxenda for any adult use | Not on the drug list | The member FAQ excludes it from non-weight-loss coverage | The table draws on the drug list and provider alert,[1][2] and on the two FAQs.[3][4] ## Why did Medi-Cal stop covering GLP-1s for weight loss? Money. The state tells members the change is part of the enacted 2025-26 budget, made to lower pharmacy costs.[4] The governor’s May 2025 proposal put the General Fund savings at $85 million in 2025-26, growing to $680 million by 2028-29 and continuing after that.[7] Those were proposal estimates, and we did not find a published figure for what the enacted budget assumed. Federal law gave California the room to do this. The Medicaid drug statute lists agents used for weight loss among the categories a state may leave out.[8] Other states made the opposite choice under that same law: [North Carolina’s Medicaid program](https://glpwatchdog.org/research/north-carolina-medicaid-and-state-health-plan-glp1) covers these drugs for obesity with prior approval. Our [Medicaid coverage page](https://glpwatchdog.org/insurance/medicaid) shows how other programs compare. ## Does Medi-Cal still cover Wegovy for MASH or heart disease? Yes for both uses, through different paths. Since April 1, 2026, Wegovy for noncirrhotic MASH needs no prior authorization, but the claim must carry diagnosis code K76.0 and/or K75.8; without one it rejects with Code 80.[2] The drug list limits this to the pens from 0.25 mg to 2.4 mg, one carton of four every 28 days.[1] We found no entry for Wegovy tablets or the Wegovy HD pen on that list. FDA approved Wegovy for MASH with moderate to advanced fibrosis, stages F2 to F3.[9] The Medi-Cal documents we read name the disease but no fibrosis stage, so a prescriber should expect the label to frame the clinical picture even though the claim checks only the code. Our [article on GLP-1s and fatty liver disease](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers what the trial showed. For cardiovascular disease, the label covers adults with established heart disease and either obesity or overweight.[9] Medi-Cal Rx reviews these requests one at a time for medical necessity.[1] It publishes no checklist of qualifying events in the documents we read, so the request has to make the case with the diagnosis, chart notes, other drugs tried and any contraindications.[1] > **A diagnosis code has to reflect a real diagnosis.** Weight-loss prescriptions cannot be moved onto these routes by changing the code. If you have not been checked for liver disease, sleep apnea or heart disease and have reason to ask, ask for the evaluation. A false code on a Medicaid claim is a legal problem for everyone involved. ## Does Medi-Cal cover Zepbound for sleep apnea? Possibly, with prior authorization. Zepbound came off the Contract Drugs List on January 1, 2026, and a claim rejects with Code 70 whatever the indication, so a pharmacy submitting it normally will see a denial.[2] The rejection message itself tells the prescriber to submit a prior authorization establishing medical necessity for an FDA-approved use.[3] Medi-Cal Rx says it will consider such requests for obstructive sleep apnea, and the FDA label covers moderate to severe sleep apnea in adults with obesity.[1][10] The documents do not state an apnea-severity threshold or a required sleep study. Expect to need one anyway, since the label indication turns on severity. Our [guide to Zepbound for sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) explains the testing and the trial results a request can lean on. ## Can Ozempic or Mounjaro be covered instead? Only for type 2 diabetes. Seven GLP-1 products stay on the list with a diabetes restriction, and a claim that lacks the qualifying diagnosis rejects with Code 80.[2] The provider FAQ closes the off-label question plainly: weight loss and related uses are no longer accepted as a justification for approval.[3] Requests for other non-weight-loss uses of these seven drugs still go to medical-necessity review.[2] ## Does Medi-Cal cover GLP-1s for teenagers? It can. Federal law requires Medicaid programs to provide medically necessary care to children under a benefit known as EPSDT, so requests for members younger than 21 are reviewed case by case, including for weight loss.[1][3] A prior authorization is still required. Specialists paneled with California Children’s Services cannot skip it, because the state says their usual panel authority does not extend to GLP-1s.[3] ## What can you do if Medi-Cal denies your GLP-1? You can ask for a State Hearing. A denial comes as a Notice of Action, and you generally have 90 days from its date to file with the California Department of Social Services.[4][5] If your GLP-1 use began by January 1, 2026, and you want to keep getting the drug during the dispute, the request generally has to go in within 10 days of receiving the notice and say so.[4][5] That continued coverage stops at the earliest of three points: the end of the current approval period, the hearing decision, or the withdrawal or closing of the hearing.[4] The first limit matters, because approvals for weight-loss use ended on December 31, 2025.[2] A hearing is most useful when the request rests on a covered route, such as a sleep apnea or cardiovascular claim denied for lack of proof. The state lists 1-800-743-8525 and 1-855-795-0634 for hearing requests.[5] Our [prior authorization and appeals guide](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers how to build the medical record, though its federal deadlines for commercial plans do not apply to Medi-Cal hearings. ## What are the options if Medi-Cal will not pay? You may pay for the drug yourself, and the state notes that you will not be reimbursed when it is used for weight loss.[4] Manufacturer savings cards are out, since Novo Nordisk’s offer excludes Medicaid and other government programs.[12] Cash programs are the alternative: as of the prices we track, Novo Nordisk sells Wegovy pens at $349 a month for most doses, and Lilly sells Zepbound from $299 at the starting dose, $399 at 5 mg and $449 at higher doses when refilled on time.[12][13] Our [guide to the cheapest GLP-1s without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares these routes. Older weight-loss drugs are not an obvious fallback. We searched the November 2026 list and found no entry for phentermine, orlistat, Qsymia or Contrave.[1] Ask your prescriber or Medi-Cal Rx before assuming any of them would be paid. If you also have Medicare, ask about the Medicare GLP-1 Bridge, a separate federal program. The federal BALANCE model could change prices or terms for states that sign up, and state Medicaid agencies can join through January 1, 2027.[11] As of November 7, 2026, CMS lists no participants on its model page, and we found no statement from California that it has joined. ## Frequently asked questions ### Is Wegovy covered by Medi-Cal for weight loss? No. Since January 1, 2026, Medi-Cal Rx has not covered Wegovy or any other GLP-1 for weight loss in members 21 or older, whatever their BMI. Earlier approvals expired on December 31, 2025. Members under 21 can still be reviewed case by case under the federal EPSDT benefit. ### Does Medi-Cal cover Zepbound? Not for weight loss, and Zepbound is off the Contract Drugs List. A pharmacy claim rejects with Code 70. Medi-Cal Rx will consider a prior authorization for moderate to severe obstructive sleep apnea, the use on the FDA label, and for members under 21 on medical-necessity grounds. ### Does Medi-Cal cover Ozempic for weight loss? No. Ozempic stays on the list only for type 2 diabetes, and the claim has to carry the diabetes diagnosis or it rejects with Code 80. The state says weight loss is no longer an accepted reason for approving a GLP-1. ### Does Medi-Cal cover Wegovy for fatty liver disease? Yes, for noncirrhotic MASH. Since April 1, 2026, Wegovy pens need no prior authorization for this use when the claim carries code K76.0 and/or K75.8. The quantity limit is one carton of four pens every 28 days. The FDA label covers MASH with stage F2 to F3 fibrosis. ### Will Medi-Cal bring back coverage of GLP-1s for weight loss? As of November 2026 nothing we read says so. The cut came through the 2025-26 state budget, so reversing it would likely take a state budget or policy decision. California could also join the federal BALANCE model by January 1, 2027, though no statement that it has done so could be found. ## References 1. California Department of Health Care Services, Medi-Cal Rx Medi-Cal Rx Contract Drugs List (November 1, 2026). medi-calrx.dhcs.ca.gov. 2026. https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/cdl/Medi-Cal_Rx_Contract_Drugs_List_FINAL.pdf 2. California Department of Health Care Services, Medi-Cal Rx GLP-1 Coverage Considerations (December 12, 2025; last updated April 6, 2026). medi-calrx.dhcs.ca.gov. 2026. https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/2025/12_A_GLP-1_Coverage_Considerations.pdf 3. California Department of Health Care Services, Medi-Cal Rx Medi-Cal Rx State Budget Policy Updates: Frequently Asked Questions (April 6, 2026). medi-calrx.dhcs.ca.gov. 2026. https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/faq/State_Budget_Policy_Updates_FAQ.pdf 4. California Department of Health Care Services, Medi-Cal Rx GLP-1 Drugs: Medi-Cal Rx Members’ Frequently Asked Questions, Version 5.0 (April 6, 2026). medi-calrx.dhcs.ca.gov. 2026. https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/faq/Members_State_Budget_Policy_Updates_FAQ.pdf 5. California Department of Health Care Services, Medi-Cal Rx Changes to GLP-1 Drug Coverage: Effective January 1, 2026. medi-calrx.dhcs.ca.gov. 2026. https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/member/GLP1_Changes.pdf 6. California Department of Health Care Services Important Plan Information: letter to Medi-Cal members on GLP-1 drugs for weight loss. medi-calrx.dhcs.ca.gov. 2025. https://www.medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/member/letters/GLP-1_Weight_Loss.pdf 7. California Department of Finance 2025-26 May Revision: Health and Human Services. ebudget.ca.gov. 2025. https://ebudget.ca.gov/2025-26/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf 8. 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 9. Novo Nordisk WEGOVY (semaglutide): prescribing information. DailyMed, U.S. National Library of Medicine. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b 10. Eli Lilly and Company ZEPBOUND (tirzepatide): prescribing information. DailyMed, U.S. National Library of Medicine. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b 11. Centers for Medicare & Medicaid Services BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model. cms.gov. 2026. https://www.cms.gov/priorities/innovation/innovation-models/balance 12. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html 13. Eli Lilly and Company Zepbound savings and self-pay options. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings --- Cite as: GLP Watchdog, Nora Bissett, "Does Medi-Cal Cover Wegovy or Zepbound? Not for Adult Weight Loss Since January 2026", published 2026-11-07. https://glpwatchdog.org/research/does-medi-cal-cover-wegovy-and-zepbound Canonical HTML page: https://glpwatchdog.org/research/does-medi-cal-cover-wegovy-and-zepbound 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.