# Does Maryland Medicaid Cover Wegovy or Zepbound? Chapter 866 and the Current Rules

By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06

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

> Chapter 866 of 2026 lets Maryland Medicaid cover obesity drugs from January 1, 2027, without requiring it, and no election was announced by November 2026. Until then one form covers Wegovy for heart disease or MASH, plus Zepbound for sleep apnea.

## Key points

- A state regulation excludes drugs used for weight control, so obesity alone is not covered.
- Chapter 866 of 2026 permits obesity drug coverage from January 1, 2027, but leaves the choice to the health department.
- Wegovy is covered for heart disease with a cardiologist involved, or for MASH with a gut or liver specialist, at a BMI read within 90 days.
- Zepbound is covered for sleep apnea with an AHI of 15 or more, and renewals stop once BMI falls under 30.
- Ozempic, Mounjaro, Trulicity and liraglutide are preferred for diabetes on the fee-for-service list.

Not for weight loss, as of November 2026. A state regulation bars Maryland Medicaid from paying for drugs “when used for weight control,” so Wegovy and Zepbound are not covered for obesity alone.[1] A 2026 law, Chapter 866, lets the program add obesity drugs from January 1, 2027 but does not require it, and the health department had not announced that it would.[2] Today one state form covers Wegovy for heart disease or the liver disease MASH and Zepbound for sleep apnea, each with prior authorization.[5]

> **About this article.** This page reads the Maryland Department of Health’s Wegovy and Zepbound prior authorization form (December 2025 version), its online clinical criteria (last revised July 2026), its transmittals on both drugs, the fee-for-service drug list updated August 6, 2026, the state regulations and Chapter 866 of 2026, as they stood on November 6, 2026. The state requires HealthChoice managed care plans to use its Wegovy criteria, and for Zepbound it tells prescribers to ask the plan, so check with yours. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker).

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

No. The pharmacy regulation lists what the program does not cover, and one item is any drug or injection used for weight control.[1] When the state added Wegovy for heart disease in 2024, it said plainly that a prescription written only to manage weight would still be refused.[6] Federal law makes that a state choice. Our explainer on [the federal rule behind Medicaid weight-loss exclusions](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) covers it.

## What does Maryland’s 2026 obesity law, Chapter 866, change?

It opens a door without pushing anyone through it. Senate Bill 496 became Chapter 866 on May 31, 2026 without the governor’s signature, and took effect October 1, 2026.[2][3] It says that from January 1, 2027 the program “may” provide comprehensive obesity coverage, defined as intensive behavioral therapy, bariatric surgery and any FDA-approved drug for chronic weight management.[2] If the department chooses to, it must tell members, and it may use prior authorization only in the same way it does for other conditions.[2]

Cost is the obstacle. The legislature’s fiscal note put the drug cost alone at as much as $449.4 million a year if the state adopts the benefit, drawing on a 2024 department estimate of $225 million to $437.7 million depending on how many people start treatment.[4] The note also says the department was weighing the federal BALANCE model, under which CMS negotiates GLP-1 prices for state Medicaid programs, but that as of March 2026 the terms had not reached states.[4] The law requires the department to report by November 1, 2027 on whether it has started the coverage and, if not, why.[2] We found no notice electing the coverage as of November 6, 2026.

*Maryland obesity drug coverage: what is law and what is not, as of November 6, 2026*

| Item | Status |
| --- | --- |
| Regulation excluding weight-control drugs | In force |
| Chapter 866 (SB 496), enacted May 31, 2026 | In force from October 1, 2026; permits, does not require, obesity coverage |
| Earliest start of obesity drug coverage | January 1, 2027, only if the department elects it |
| Member notice of the election | None found |
| Department report to the legislature | Due by November 1, 2027 |

## When does Maryland Medicaid pay for Wegovy?

For two uses, both on one form from the Office of Pharmacy Services. The form says incomplete requests will not be reviewed, and the prescriber also attests that the patient tried a weight-loss program in the past six months without success.[5] Approval lasts four months at first, then six months at a time.[15] Since July 2026 the state’s criteria also list the Wegovy tablet, for the heart use only, on the same cardiologist and BMI terms and at one tablet a day.[15]

*Maryland Medicaid Wegovy criteria, from the MDH prior authorization form (December 2025 version), the state's clinical criteria and the Wegovy label*

| Use | Requirements | Prescriber |
| --- | --- | --- |
| Lowering heart attack and stroke risk | A past heart attack, a past stroke, or leg artery disease with symptoms (ABI under 0.85 with claudication, a revascularization or an amputation); BMI of 27 or more recorded within 90 days; no other GLP-1 | A cardiologist, or another doctor in consultation with one |
| MASH with F2 to F3 fibrosis | Noncirrhotic MASH; moderate to advanced fibrosis, as on the label, confirmed by biopsy or an accepted noninvasive test within 180 days; no other GLP-1 and no other MASH drug | A gastroenterologist or liver specialist, or in consultation with one |

Two points need care. The 2024 notice that opened the heart route limited it to adults without type 1 or type 2 diabetes, and told managed care plans to use the same criteria.[6] Neither the December 2025 form nor the state’s criteria, last revised July 2026, repeats that limit. If a plan cites it, ask for the current criteria; people with diabetes can also use Ozempic on the diabetes route.[5][15][8] And the specialist requirement is real: a request from a primary care doctor needs a cardiologist or liver specialist named as consulting. The liver use carries accelerated approval, pending a confirmatory trial.[12] Our page on [semaglutide for MASH](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers the evidence for it.

## Does Maryland Medicaid cover Zepbound for sleep apnea?

Yes, since February 5, 2025, for adults with obesity, the group the label covers.[7][11] The form asks for a sleep study, in a lab or at home, scoring 15 or more on the apnea-hypopnea index, a BMI from 30 up recorded within 90 days, a sleep specialist, lung doctor or other clinician experienced in sleep apnea, and no second GLP-1.[5] It sets no CPAP step.[5]

Renewal has a twist. Approvals renew six months at a time on the prescriber’s word that the drug is helping, and after a year the sleep apnea has to be documented again each year, by a sleep study or CPAP data.[5][7][15] But the state also says renewals will not be authorized once BMI is under 30.[7] Zepbound lowers weight, so a patient who does well can lose coverage by crossing that line, even with sleep apnea still present. Raise this with the prescriber early. Our guide to [Zepbound for obstructive sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) explains what the trials found.

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

Yes. On the fee-for-service drug list updated August 6, 2026, Ozempic, Mounjaro, Trulicity and generic liraglutide (Victoza) are preferred drugs, and Rybelsus and Byetta need prior authorization as non-preferred drugs.[8] The legislature’s fiscal note confirms that the program covers these diabetes drugs for their approved uses other than obesity.[4]

## How do you file, and how long does an appeal take?

Fee-for-service requests go to the Office of Pharmacy Services by fax at (866) 440-9345; the phone line is (833) 325-0105.[5] HealthChoice members file through their plan, and the state tells prescribers to contact the plans for their process.[7]

A plan member has 60 days from the plan’s notice to appeal to the plan, and then 120 days from the plan’s decision to ask the Office of Administrative Hearings for a state fair hearing.[9] Plans must offer a faster review when waiting could seriously harm the member’s health.[9] For fee-for-service denials, federal rules cap the hearing window at 90 days from the date the notice is mailed, so use the date on your notice.[10] 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 [Maryland state page](https://glpwatchdog.org/states/maryland) keeps the basics together.

## What can you do until Maryland adds coverage?

Paying cash is the usual route, and Lilly’s savings card excludes Medicaid members.[13] In the figures we track, Novo Nordisk sells most Wegovy pen doses for $349 a month, and Lilly’s Zepbound KwikPen or vial runs $299 at the starting dose, $399 at 5 mg and $449 at higher doses refilled on time.[13][14] Check each program’s rules for government coverage first. Our list of the [lowest GLP-1 prices without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them.

## Frequently asked questions

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

No. A state regulation excludes drugs used for weight control. As of November 2026 Maryland Medicaid covers Wegovy with prior authorization only to lower heart risk in people with a past heart attack or stroke or with leg artery disease, or to treat MASH with F2 to F3 fibrosis, with a specialist involved.

### Will Maryland Medicaid cover weight-loss drugs in 2027?

Possibly. Chapter 866 of 2026 allows, but does not require, the program to cover obesity drugs from January 1, 2027. The health department must notify members if it chooses to and report to the legislature by November 1, 2027. No election had been announced as of November 2026.

### Does Maryland Medicaid cover Zepbound for sleep apnea?

Yes, for adults with obesity. The request needs a sleep study with an AHI of 15 or more, a BMI from 30 up measured within 90 days, and a sleep specialist or lung doctor. Renewals run six months, and the state stops renewing once BMI falls under 30.

### Does Maryland Medicaid require a cardiologist for Wegovy?

Yes. For the heart route, the state form asks that Wegovy be prescribed by a cardiologist or in consultation with one. For the MASH route, it asks for a gastroenterologist or liver specialist.

### Does Maryland Medicaid cover Ozempic and Mounjaro?

Yes, for type 2 diabetes. Both are preferred drugs on the fee-for-service list updated August 6, 2026, along with Trulicity and generic liraglutide.

## References

1. Maryland Department of Health COMAR 10.09.03.05: Pharmacy Services, Limitations. Division of State Documents, dsd.maryland.gov. 2026. https://dsd.maryland.gov/regulations/Pages/10.09.03.05.aspx
2. Maryland General Assembly Chapter 866 of 2026 (Senate Bill 496): Maryland Medical Assistance Program, Coverage for the Treatment of Obesity, Authorization. mgaleg.maryland.gov. 2026. https://mgaleg.maryland.gov/2026RS/Chapters_noln/CH_866_sb0496e.pdf
3. Maryland General Assembly SB 496, 2026 Regular Session: bill status and history. mgaleg.maryland.gov. 2026. https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0496?ys=2026RS
4. Department of Legislative Services Fiscal and Policy Note, Senate Bill 496 (Enrolled, Revised), 2026 Session. mgaleg.maryland.gov. 2026. https://mgaleg.maryland.gov/2026RS/fnotes/bil_0006/sb0496.pdf
5. Maryland Department of Health, Office of Pharmacy Services Wegovy and Zepbound Prior Authorization Form (MDH 12/2025). health.maryland.gov. 2025. https://health.maryland.gov/mmcp/pap/docs/PA%20Forms/Wegovy%20or%20Zepbound%20PA%20form.pdf
6. Maryland Department of Health PT 35-25: Coverage of Wegovy for Overweight or Obese Adults with Cardiovascular Disease, Effective September 15, 2024. health.maryland.gov. 2024. https://health.maryland.gov/mmcp/provider/Documents/transmittals/PT35-25-Coverage-of-Wegovy-for-Overweight-or-Obese-Adults-with-Cardiovascular-Disease.pdf
7. Maryland Department of Health PT 74-25: Notice of Zepbound Coverage Effective February 5, 2025 (copy posted by Aetna Better Health of Maryland). aetnabetterhealth.com. 2025. https://es.aetnabetterhealth.com/content/dam/aetna/medicaid/pdfs/formulary/guidelines/PT-74-25-Notice-of-Zepbound-Coverage-ua.pdf
8. Maryland Department of Health, Office of Pharmacy Services Medicaid Pharmacy Program Preferred Drug List, effective July 1, 2026, updated August 6, 2026. health.maryland.gov. 2026. https://health.maryland.gov/mmcp/pap/docs/PDL-updated-8-6-2026.pdf
9. Maryland Department of Health COMAR 10.67.09.05: MCO Appeal Process for Enrollees. Division of State Documents, dsd.maryland.gov. 2026. https://dsd.maryland.gov/regulations/Pages/10.67.09.05.aspx
10. Centers for Medicare & Medicaid Services 42 CFR 431.221: Request for hearing. eCFR. 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E/section-431.221
11. 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
12. 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
13. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings
14. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html
15. Maryland Department of Health, Office of Pharmacy Services Clinical Criteria: Wegovy, Wegovy tablet and Zepbound. health.maryland.gov. 2026. https://health.maryland.gov/mmcp/pap/Pages/Clinical-Criteria.aspx

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Cite as: GLP Watchdog, Nora Bissett, "Does Maryland Medicaid Cover Wegovy or Zepbound? Chapter 866 and the Current Rules", published 2026-11-06. https://glpwatchdog.org/research/maryland-medicaid-glp1-coverage

Canonical HTML page: https://glpwatchdog.org/research/maryland-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.