# Does Louisiana Medicaid Cover Wegovy or Zepbound? Act 898 and Today's Rules

By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-07

Canonical page: https://glpwatchdog.org/research/louisiana-medicaid-glp1-coverage

> Louisiana passed Act 898 in June 2026 to make Medicaid pay for weight-loss drugs, but the law waits on an appropriation that neither 2026 budget act contains. Until then: Wegovy for heart risk or MASH, Zepbound for sleep apnea, diabetes drugs, PA lines and appeals.

## Key points

- Louisiana's pharmacy manual still bars weight-loss drugs from coverage, with orlistat as the only exception.
- Act 898 orders the health department to cover them, but only after a specific appropriation, which neither 2026 budget act contains.
- Wegovy is paid for heart risk at age 45 and up with a BMI of 27 or more, a past heart attack, stroke or artery disease, and no diabetes.
- Zepbound is paid for moderate to severe sleep apnea, when the AHI is at least 15 and the BMI at least 30, plus a signed treatment agreement.
- Ozempic, Mounjaro, Rybelsus and Trulicity are preferred for diabetes, with a diagnosis code checked at the pharmacy.

Not yet. As of November 2026, Louisiana Medicaid still excludes drugs used for weight loss, apart from orlistat, so Wegovy and Zepbound are not covered to lose weight.[2] A 2026 law, Act 898, orders the state to cover FDA-approved weight-loss drugs, but it only takes effect once the legislature passes money for it, and neither of the 2026 budget acts we read does so.[3][6][7] Today the state pays for Wegovy to lower heart risk or to treat the liver disease MASH, and for Zepbound to treat sleep apnea, each through clinical authorization with a signed treatment agreement.[1][8][17]

> **About this article.** This page reads Louisiana’s single preferred drug list (effective July 1, 2026, updated October 23, 2026), the current Wegovy and Zepbound criteria linked from it, the Medicaid pharmacy manual issued March 30, 2026, the health department’s 2026 bulletins, Act 898 and the 2026 budget acts, as they stood on November 7, 2026. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker).

## Will Louisiana Medicaid pay for Wegovy or Zepbound to lose weight?

No. The pharmacy manual lists the drugs Louisiana Medicaid will not pay for, and the first entry on that list is any drug used to lose or gain weight, with a single exception: orlistat, sold as Xenical.[2] When the state added its heart-risk route for Wegovy in 2024, one of its health plans told doctors plainly that weight-loss drugs “still remain a Louisiana Medicaid benefit exclusion.”[9]

Under federal law, each state may make that call: weight-loss drugs sit on a short list of medicines a Medicaid program may leave out.[10] One drug list governs everyone. The state says its list applies to all Medicaid members, whether they are in one of the managed care plans or in fee-for-service, and that every plan uses the same request form.[1] Our explainer on [why Medicaid treats Ozempic and Wegovy differently](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) covers the federal side.

## What does Louisiana Act 898 do, and when does coverage start?

Act 898 began as Senate Bill 433. It passed the Senate 31 to 0 and the House 85 to 11, and the governor signed it on June 9, 2026.[4] It adds a section to state law saying the health department “shall provide Medicaid coverage” for FDA-approved weight-loss drugs that are medically necessary and prescribed by a licensed provider.[3] The department writes the criteria and may require prior authorization, but neither the department nor any managed care plan may require step therapy, and the department must run the benefit in a way that “ensures fiscal sustainability.”[3]

The catch is in Section 2. The coverage section takes effect only when a separate act “containing a specific appropriation of monies” for it becomes effective.[3] The fiscal note on the final bill assumed a January 1, 2027 start and put the cost at $10 million in the 2026-27 fiscal year, of which $3 million is state money, rising to $21.2 million the year after. The fiscal office added that it could not confirm the department’s estimate.[5]

*Louisiana Act 898 and its funding, from the legislature's records as of November 7, 2026*

| Date | Step | What it means for coverage |
| --- | --- | --- |
| April 29, 2026 | Senate passes SB 433, 31 to 0 | None yet |
| May 29, 2026 | House passes it, 85 to 11 | None yet |
| June 1, 2026 | Fiscal note: $10 million in fiscal 2026-27, assuming a January 1, 2027 start | An estimate, not money |
| June 9, 2026 | Signed; becomes Act 898 | Coverage section waits for an appropriation |
| June 18, 2026 | 2026-27 budget (HB 1) signed as Act 3 | No line for weight-loss drugs found |
| 2026 session | Supplemental budget (HB 312) signed as Act 961 | No line for weight-loss drugs found |

We searched the full text of both 2026 budget acts and found no money for this benefit. The 2026-27 budget, Act 3, has no line for weight-loss drugs or for Act 898, so there was nothing on that subject for the governor to veto.[6] The supplemental budget, Act 961, has none either.[7] So as of November 7, 2026, the January 2027 date in the fiscal note is only a planning assumption. The health department’s provider bulletins through November 2, 2026 do not announce a start either.[20] Until the legislature funds the law or the department announces coverage, plan on the current rules below.

## When will Louisiana Medicaid pay for Wegovy?

For heart disease, and for a liver disease called MASH. Wegovy is on the state’s list of drugs that need extra clinical information before a claim pays, and a signed patient treatment agreement goes with the first request.[1][8] The current criteria, revised in November 2025 and in use since March 2026, set these conditions for a first approval on the heart route:[8]

*Louisiana Medicaid Wegovy heart-risk criteria, from the state's current Wegovy criteria document*

| Requirement | What the request must show |
| --- | --- |
| Age | 45 or older on the date of the request |
| BMI | 27 to under 35 with the date of the latest reading; at 35 or higher, proof of an evaluation or referral for weight-loss surgery as well |
| Heart disease | A prior heart attack, a prior stroke, or symptomatic peripheral artery disease (ABI under 0.85 with claudication, a past revascularization, or an amputation) |
| Heart care already in place | Statin and antiplatelet treatment (or a stated medical reason for skipping some of it), and blood pressure under 130/80 or at least two blood pressure drugs; the exact list differs for heart attack, stroke and artery disease |
| Diabetes | No type 1 or type 2 diabetes |
| Other drugs | No other semaglutide product or GLP-1 alongside it |
| Standard care | Lifestyle counseling and a lower-calorie diet with more activity, on top of heart treatment |
| Paperwork | The uniform prior authorization form plus the signed Wegovy treatment agreement |

The age line is the unusual part. Wegovy’s label covers any adult with established heart disease and overweight or obesity, but Louisiana starts at 45.[8][14] The heart-care line matters too: a request after a heart attack has to state the patient’s yearly risk level and show the statin, blood pressure and aspirin picture, so a thin request is easy to deny.[8] People with diabetes are steered to the diabetes drugs instead, where Ozempic, the same medicine as Wegovy, is a preferred choice.[1][8]

The first approval lasts six months. To renew, the prescriber sends dated baseline and current weights. Losing at least 5% earns another six months. Under 5%, a three-month extension is possible with a clinical reason, but a second miss after a three-month approval ends coverage.[8] The November 2025 revision dropped the older rule that renewals had to be on a maintenance dose.[8]

The MASH route covers the injection only. It requires an adult aged 18 or older with MASH confirmed by a liver biopsy in the prior six months, or by elastography, CT or MRI in the prior three months; fibrosis at stage F2 or F3; no decompensated cirrhosis; and a gastroenterologist or liver specialist prescribing or consulting.[8] Approval lasts 12 months, and renewal needs a positive response and no progression to stage 4 fibrosis.[8] That matches the label, which approves Wegovy for MASH with moderate to advanced fibrosis under accelerated approval.[14]

## Does Louisiana Medicaid cover Zepbound for sleep apnea?

Yes, with clinical authorization. Zepbound is on the drug list with the same kind of clinical edit as Wegovy and its own patient treatment agreement.[1] The weight-loss exclusion rules out weight alone, and the state’s Zepbound criteria, written in June 2025 and in use since January 2026, cover one use: moderate to severe obstructive sleep apnea, which the label approves in adults with obesity.[2][13][17]

*Louisiana Medicaid Zepbound sleep apnea criteria for a first approval*

| Requirement | What the request must show |
| --- | --- |
| Age | 18 or older |
| Sleep study | Moderate to severe obstructive sleep apnea with an AHI of 15 or more, with the dated results |
| Apnea type | No central or mixed sleep apnea |
| CPAP | Used alongside CPAP or another PAP device, a history of not tolerating it, or a clinical reason to go without it |
| BMI | 30 or higher, with the date of the latest reading |
| Diabetes | No type 1 or type 2 diabetes |
| Other drugs | No other tirzepatide product or GLP-1 alongside it |
| Paperwork | The uniform prior authorization form plus the signed Zepbound treatment agreement |

The first approval lasts six months.[17] Renewal needs dated weights showing at least 5% loss, or that the loss held with no regain, plus at least three months of follow-up notes or tests showing a lower AHI and fewer symptoms. Passing earns 12 more months. Under 5%, a three-month extension is possible with a clinical reason, but a second miss ends coverage.[17] Our guide to [Zepbound for sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) explains the trials behind that indication.

## Does Louisiana Medicaid cover Ozempic and Mounjaro for diabetes?

Yes. Ozempic, Rybelsus, Mounjaro and Trulicity are preferred drugs on the October 2026 list, while Victoza and generic liraglutide and exenatide need prior authorization.[1] Preferred status does not mean no checks. Pharmacy claims for these drugs need a diagnosis code, and the pharmacy edits set minimum ages: 18 for Ozempic and Rybelsus, and 10 for Mounjaro and Trulicity, after the state lowered Mounjaro’s age limit in early 2026.[18] The pharmacy also screens for two GLP-1s at once.[1][18]

## How do you request prior authorization, and who do you call?

The prescriber files the request; the manual says pharmacist or member calls are not accepted.[2] Requests go to the member’s plan, and the state promises an answer within 24 hours, with an emergency supply of at least 72 hours allowed while a request is pending.[2] These are the prior authorization lines printed on the October 2026 drug list:[1]

*Pharmacy prior authorization phone numbers on Louisiana's drug list, updated October 23, 2026*

| Coverage | Phone |
| --- | --- |
| Aetna Better Health of Louisiana | 1-855-242-0802 |
| AmeriHealth Caritas Louisiana | 1-800-684-5502 |
| Healthy Blue | 1-844-521-6942 |
| Humana Healthy Horizons | 1-800-555-2546 |
| Louisiana Healthcare Connections | 1-866-595-8133 |
| Fee-for-service (Legacy Medicaid) | 1-866-730-4357 |

Healthy Blue leaves Louisiana Medicaid when its contract ends on December 31, 2026. Its members move to another plan on January 1, 2027, by their own choice or by assignment, and a pharmacy approval issued by Healthy Blue stays valid until its own end date.[19] Plan renewal requests around that date with the new plan in mind.

## Is any weight-loss drug covered in Louisiana?

Orlistat is the one exception to the exclusion.[2] Xenical appears on the drug list with age, diagnosis, clinical and quantity edits, so the prescriber should expect paperwork for it too.[1] Its effect is far smaller than a GLP-1’s. If Act 898 is funded, the department will have to publish new criteria for the GLP-1 weight-loss drugs, and those criteria cannot include step therapy, such as trying orlistat first.[3]

## How do you appeal a denial in Louisiana?

Read the reason first. A denial for a missing sleep study, BMI date or treatment agreement is usually fixed by resubmitting. A request for weight loss alone has nothing to win on appeal until Act 898 takes effect.[2][3]

Most members are in a managed care plan. Federal rules give a plan member 60 days from the denial notice to appeal to the plan, then at least 90 and up to 120 days from the plan’s decision to ask for a state fair hearing.[11][12] Louisiana’s own hearing page could not be opened, so check the exact deadline printed on your notice. Our walkthrough of [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to put in the file, and the [Louisiana state page](https://glpwatchdog.org/states/louisiana) keeps the basics in one place.

## What can you do while Louisiana Medicaid will not pay?

Cash is the main route, and manufacturer copay cards will not help: Lilly’s savings card terms exclude anyone enrolled in Medicaid.[15] In the figures we track, Novo Nordisk’s self-pay price for most Wegovy pen doses is $349 a month, and Lilly’s self-pay Zepbound runs $299 at the starting dose, $399 at 5 mg and $449 at higher doses refilled on time.[15][16] Check each offer’s terms on government coverage before you enroll. Our list of the [lowest-cost GLP-1 routes without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them.

## Frequently asked questions

### Is Wegovy covered by Louisiana Medicaid for weight loss?

No. As of November 2026 Louisiana Medicaid excludes drugs used for weight loss except orlistat. It does pay for Wegovy with clinical authorization to cut heart risk, for people aged 45 and up whose BMI is at least 27, who have had a heart attack or stroke or have artery disease in the legs, and who do not have diabetes. At a BMI of 35 or more the request must also show a weight-loss surgery evaluation or referral. A second route covers the injection for the liver disease MASH with F2 or F3 fibrosis.

### When will Louisiana Medicaid start covering weight-loss drugs?

Act 898, signed June 9, 2026, requires coverage, but only after the legislature passes a specific appropriation for it. The fiscal note assumed a January 1, 2027 start, yet neither 2026 budget act contains that money, so as of November 2026 no start date is set.

### Does Louisiana Medicaid cover Zepbound?

Yes, for obstructive sleep apnea, not for weight loss. The state's criteria require an adult with moderate to severe apnea (AHI of 15 or more on a dated sleep study), a BMI of 30 or more, no diabetes, use alongside CPAP or a reason to go without it, and a signed treatment agreement. The first approval lasts six months.

### Does Louisiana Medicaid cover Ozempic?

Yes, for type 2 diabetes. Ozempic is a preferred drug on the October 2026 list. Pharmacy claims need a diabetes diagnosis code, and the minimum age is 18.

### Does Louisiana Act 898 allow step therapy for weight-loss drugs?

No. Under the law, the health department may require prior authorization and set its own criteria, but it bars both the department and the managed care plans from requiring step therapy for these drugs.

## References

1. Louisiana Department of Health Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List (NPDL), effective July 1, 2026, updated October 1, 2026 (Internet Archive capture of October 23, 2026). ldh.la.gov via web.archive.org. 2026. https://web.archive.org/web/20261023174223/https://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf
2. Louisiana Medicaid Program Pharmacy Benefits Management Services provider manual, Chapter 37, Section 37.1: Covered Services, Limitations, and Exclusions (issued March 30, 2026). lamedicaid.com. 2026. https://www.lamedicaid.com/provweb1/Providermanuals/manuals/PHARMACY/PHARMACY.pdf
3. Louisiana Legislature Act No. 898 (Senate Bill No. 433), 2026 Regular Session: enacting R.S. 46:460.38, weight loss medications; required coverage. legis.la.gov. 2026. https://legis.la.gov/legis/ViewDocument.aspx?d=1481257
4. Louisiana Legislature SB 433, 2026 Regular Session: bill history and votes. legis.la.gov. 2026. https://legis.la.gov/legis/BillInfo.aspx?s=26RS&b=SB433&sbi=y
5. Legislative Fiscal Office Fiscal Note on SB 433 (Enrolled): Medicaid coverage for weight loss medications, June 1, 2026. legis.la.gov. 2026. https://legis.la.gov/legis/ViewDocument.aspx?d=1479545
6. Louisiana Legislature House Bill No. 1, 2026 Regular Session (Act No. 3): general appropriations for Fiscal Year 2026-2027. legis.la.gov. 2026. https://legis.la.gov/legis/ViewDocument.aspx?d=1481824
7. Louisiana Legislature House Bill No. 312, 2026 Regular Session (Act No. 961): supplemental appropriations for Fiscal Year 2025-2026. legis.la.gov. 2026. https://legis.la.gov/legis/ViewDocument.aspx?d=1481867
8. Louisiana Department of Health Louisiana Medicaid clinical authorization criteria: Semaglutide (Wegovy), revised November 2025, implemented March 2026. ldh.la.gov. 2025. https://ldh.la.gov/assets/docs/BayouHealth/Pharmacy/2_10_26/Wegovy.09192025.pdf
9. Louisiana Healthcare Connections Medicaid Pharmacy Coverage of Wegovy for Cardiovascular Indications Only. louisianahealthconnect.com. 2024. https://louisianahealthconnect.com/newsroom/medicaid-pharmacy-coverage-of-wegovy--for-cardiovascular-indicat.html
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. Centers for Medicare & Medicaid Services 42 CFR 438.402: Grievance and appeal systems, general requirements. eCFR. 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-F/section-438.402
12. Centers for Medicare & Medicaid Services 42 CFR 438.408: Resolution and notification of grievances and appeals. eCFR. 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-F/section-438.408
13. 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
14. 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
15. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings
16. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html
17. Louisiana Department of Health Louisiana Medicaid clinical authorization criteria: Tirzepatide (Zepbound), created June 2025, implemented January 2026. ldh.la.gov. 2025. https://ldh.la.gov/assets/medicaid/PharmPC/12_5_25/4/Zepbound.06052025.pdf
18. Louisiana Department of Health Point-of-sale edits: Diabetes, Hypoglycemics, Incretin Mimetics/Enhancers (updated July 2026). ldh.la.gov. 2026. https://ldh.la.gov/assets/medicaid/pharmacy/links/2026-07-16/pos-diabetes-hypoglycemics-incretin-mimetics-enhancers-07132026.pdf
19. Louisiana Department of Health Informational Bulletin 26-12: Important Information Regarding Healthy Blue Transition, September 1, 2026. ldh.la.gov. 2026. https://ldh.la.gov/assets/docs/BayouHealth/Informational_Bulletins/2026/IB26-12.pdf
20. Louisiana Department of Health Medicaid Informational Bulletins, 2026 (through Informational Bulletin 26-20, November 2, 2026). ldh.la.gov. 2026. https://ldh.la.gov/page/informational-bulletins

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Cite as: GLP Watchdog, Nora Bissett, "Does Louisiana Medicaid Cover Wegovy or Zepbound? Act 898 and Today's Rules", published 2026-11-07. https://glpwatchdog.org/research/louisiana-medicaid-glp1-coverage

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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.