# Does Mississippi Medicaid Cover Wegovy and Zepbound? Coverage, Criteria and Who Stays On

By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06 | Updated: 2026-11-10

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

> Mississippi Medicaid has paid for weight-loss drugs since July 2023 and updated its criteria on July 1, 2026. Which drugs are preferred, the BMI lines, renewal rules, how to file with Gainwell, and a study showing a quarter of adult starters still adherent at a year.

## Key points

- Mississippi Medicaid has covered selected weight-loss drugs since July 1, 2023, under a federally approved state plan change.
- Wegovy, Zepbound, Saxenda and Foundayo are all preferred on the November 2026 drug list; Wegovy and Saxenda from age 12.
- Adults qualify at a BMI of 30, or lower with a weight-related condition, one drug at a time and not during pregnancy.
- Older criteria renewed six months at a time for 5% weight loss, steady refills and a target dose.
- In a study of 3,968 adult members, 25% were still adherent after 12 months.

Yes. Mississippi Medicaid has covered selected weight-loss drugs since July 1, 2023, with prior authorization, and as of November 2026 its criteria for those drugs were last updated July 1, 2026.[1][2] Wegovy, Zepbound, Saxenda and the Foundayo pill are all preferred on the state’s November 2026 drug list.[15] A study by university researchers and Medicaid staff found that only about a quarter of adults who started were still taking the drug regularly a year later.[4]

> **About this article.** This page reads the federal approval of Mississippi’s coverage, the Division of Medicaid’s prior authorization page as archived on July 3, 2026, the state’s January 2025 criteria, its March 2026 drug review board minutes and a peer-reviewed study of its members, all on November 1, 2026, and the drug list effective November 1, 2026 on November 6. The current criteria file, dated July 1, 2026, still would not load from the Division’s website and has no archived copy. Details from it below come from search-engine copies and are marked as such; confirm them with the plan or the prior authorization unit before filing. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker).

## Does Mississippi Medicaid cover Wegovy and Zepbound for weight loss?

Mississippi Medicaid does, which sets it apart in its region. Under federal law, each state may decide whether Medicaid pays for weight-loss drugs.[6] In 2023 Mississippi asked CMS to add “selected drugs that treat obesity,” and CMS approved the change effective July 1, 2023, with the state plan saying the covered drugs are those “listed on the state’s website.”[1] Neighboring [Louisiana](https://glpwatchdog.org/research/louisiana-medicaid-glp1-coverage) and Alabama still exclude weight-loss use. Our explainer on [how states choose on Medicaid weight-loss coverage](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) covers the federal side.

The list on the state’s website is the anti-obesity prior authorization packet. As archived on July 3, 2026, the Division’s prior authorization page showed that packet updated July 1, 2026, next to a separate packet for Wegovy in the liver disease MASH dated October 30, 2025.[2]

## Which drugs are covered, and from what age?

The January 2025 criteria, the latest version we could open, named Saxenda and Wegovy as preferred from age 12 and Xenical as non-preferred. Qsymia was left out because its maker does not pay federal Medicaid rebates, and phentermine because it has not shown longer-term health benefits.[3] The November 2026 drug list now names Foundayo, Saxenda, Wegovy and Zepbound as preferred, with orlistat, Xenical and generic liraglutide non-preferred, and it caps each drug at a month’s supply.[15] A notice from the state’s October 27, 2026 drug committee meeting proposes moving Saxenda to non-preferred on January 1, 2027, pending approval.[16] Search-engine copies of the July 2026 criteria give the ages as 12 and up for Saxenda or Wegovy and 18 and up for Foundayo and Zepbound. That fits the labels: Wegovy is approved from age 12, while Zepbound and Foundayo are approved for adults.[10][11][12]

*Mississippi Medicaid anti-obesity drugs in the January 2025 criteria and the drug list effective November 1, 2026*

| Drug | January 2025 criteria | November 2026 drug list |
| --- | --- | --- |
| Wegovy | Preferred, age 12 and up | Preferred |
| Saxenda | Preferred, age 12 and up | Preferred (non-preferred proposed from January 1, 2027) |
| Zepbound | Not listed | Preferred |
| Foundayo | Not yet approved | Preferred |
| Xenical (orlistat) | Non-preferred | Non-preferred |
| Qsymia, phentermine | Not covered | Not listed |

## What BMI do you need for Mississippi Medicaid to cover a GLP-1?

For adults, a BMI of 30 or more qualifies on its own. In the January 2025 version, a lower BMI could qualify with at least one weight-related condition confirmed in the record: high blood pressure or high cholesterol shown by prescription claims, diabetes or prediabetes, sleep apnea on a prior sleep study, heart disease, or fatty liver disease.[3] Search copies of the July 2026 file give the lower band as 27 to 29 with a comorbidity. Teenagers 12 to 17 qualified for Wegovy at a BMI above the 95th percentile for age and sex.[3]

Some rules ran through every version we saw. Only one weight-loss drug is covered at a time, and the November 2026 list sends any request to combine one with a diabetes GLP-1 to clinical review,[15] and the state does not pay for these drugs during pregnancy or while breastfeeding.[3] The first request carries a treatment plan with a six-month goal, and the prescriber confirms that diet and activity counseling took place.[3]

## How does renewal work?

In the January 2025 criteria, approvals ran six months, and renewal depended on three things: steady refills (three paid claims in the past 105 days), reaching a target dose (1.7 mg or 2.4 mg for Wegovy), and weight loss.[3] Losing 5% or more earned six more months. A loss of 1% to 4% could earn three months if titration had been delayed by side effects or illness, and a loss under 1% meant denial, with a suggestion to try another covered drug.[3] The November 2026 drug list says Wegovy, Zepbound and Foundayo go through the state’s automated prior authorization check, that a manual request may be needed when that check is not met, and that reauthorization after 12 months needs a manual request.[15] The same entry also says “All agents MANUAL PA required,” so a prescriber should be ready to file a manual request for any of these drugs.[15] Search copies of the July 2026 criteria also describe 12-month approvals and a 5% check; ask the plan for the exact renewal rules before the first approval runs out.

## How many Mississippi Medicaid members stay on a GLP-1?

Fewer than the trials would suggest. A study by University of Mississippi researchers and Division of Medicaid staff followed 3,968 adults who started a weight-loss GLP-1 between July 2023 and June 2025.[4] It is a retrospective look at claims, not a trial. Most were women (92.5%) and about half were Black.[4]

*Mississippi Medicaid adults starting a weight-loss GLP-1, from Bazzazzadehgan et al., Advances in Therapy, 2026*

| Time on treatment | Adherent (drug on hand 80% of days) | Persistent (no 60-day gap) |
| --- | --- | --- |
| 3 months | 56.85% | 72.98% |
| 6 months | 38.16% | 51.03% |
| 12 months (subgroup) | 25.26% | 36.67% |

Starting in 2023, younger age, Black race, type 2 diabetes and heart disease were linked with worse patterns, while being in a managed care plan and having high blood pressure were linked with better ones.[4] At its March 2026 meeting, the state’s drug review board heard that people who started in 2025 did substantially better than the 2023 group, when shortages interrupted supply, but still trailed published figures. Board members raised the need for more flexible dose increases for people struggling with side effects, and the board voted for the Division to look for the barriers.[5] Our look at what people pay and whether they stay on GLP-1s puts these numbers next to other groups.

## Does Mississippi Medicaid cover Wegovy for MASH?

It has a separate prior authorization packet for that use, dated October 30, 2025.[2] We could not open it. Wegovy’s label covers noncirrhotic MASH with moderate to advanced fibrosis (stages F2 to F3) in adults, so expect the request to need proof of the fibrosis stage.[11] Our page on [GLP-1s and fatty liver disease](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers the evidence. We found no separate heart or sleep apnea packet; people with those conditions and a qualifying BMI generally fall under the main weight-loss criteria, where sleep apnea and heart disease were listed as qualifying conditions in 2025.[2][3]

## How do you file, and how do appeals work?

Gainwell Technologies handles pharmacy prior authorization for the state. The prescriber files through Gainwell’s provider portal or by fax at 866-644-6147; the line is 833-660-2402.[2] The January 2025 form covered fee-for-service, MississippiCAN managed care and CHIP members alike.[3] People with type 2 diabetes use the diabetes GLP-1s instead, where the November 2026 list prefers Mounjaro, Ozempic, Trulicity, Victoza and Byetta.[15] The state’s page also links a pharmacy reconsideration form for a request that was turned down.[2]

For a formal appeal, federal rules give a managed care member 60 days from the plan’s notice to appeal to the plan, then 90 to 120 days from the plan’s decision to request a state fair hearing.[7][8] A fee-for-service hearing request has to be allowed at least a reasonable window, capped at 90 days from the notice.[9] Use the date on your notice. Our walkthrough of [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to send, and the [Mississippi state page](https://glpwatchdog.org/states/mississippi) keeps the basics together.

## What if you do not qualify?

Cash is the fallback, 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 charges $299 for Zepbound at the starting dose, $399 at 5 mg and $449 at 7.5 mg and up when each refill comes within 45 days.[13][14] Check each program’s terms on government coverage first. Our list of the [least expensive ways to pay cash for a GLP-1](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them.

## Frequently asked questions

### Does Mississippi Medicaid cover Wegovy for weight loss?

Yes, with prior authorization. Mississippi Medicaid has covered selected weight-loss drugs since July 1, 2023, and Wegovy has been a preferred drug from age 12. Adults qualify at a BMI of 30 or more, or lower with a weight-related condition.

### Does Mississippi Medicaid cover Zepbound?

Yes, with prior authorization. Zepbound is a preferred anti-obesity drug on the Mississippi Medicaid drug list effective November 1, 2026, and its label limits weight-loss use to adults.

### How long does a Mississippi Medicaid GLP-1 approval last?

In the January 2025 criteria, approvals lasted six months, and renewal needed regular refills, a target dose and at least 5% weight loss for another six months. Copies of the July 2026 criteria describe 12-month approvals, so ask your plan for the current rule.

### Does Mississippi Medicaid cover weight-loss drugs during pregnancy?

No. The state's criteria say it does not pay for obesity drugs during pregnancy or while breastfeeding.

### How many Mississippi Medicaid members stay on GLP-1s?

In a study of 3,968 adult members who started between July 2023 and June 2025, 38% were still adherent at six months, and in a 12-month subgroup 25% were adherent and 37% had no gap of 60 days or more.

## References

1. Centers for Medicare & Medicaid Services Mississippi State Plan Amendment 23-0013: Drugs to Treat Obesity, approval letter and approved page (effective July 1, 2023). medicaid.gov. 2023. https://www.medicaid.gov/medicaid/spa/downloads/MS-23-0013.pdf
2. Mississippi Division of Medicaid Drug Prior Authorization (PA) page (Internet Archive capture of July 3, 2026). medicaid.ms.gov via web.archive.org. 2026. https://web.archive.org/web/20260703193427/https://medicaid.ms.gov/pharmacy-prior-authorization/
3. Mississippi Division of Medicaid Select Covered Obesity Medications PA Criteria, January 1, 2025 (Internet Archive capture of March 25, 2025). medicaid.ms.gov via web.archive.org. 2025. https://web.archive.org/web/20250325062052/https://medicaid.ms.gov/wp-content/uploads/2024/12/Anti-obesity-Select-Agents-PA-Criteria-1_1_2025.V5.pdf
4. Bazzazzadehgan S, Pittman E, Lin LY, Qi J, Ly-Ha A, Smith D, Kirby T, Vest TA, Bentley JP, Bhattacharya K Real-World Adherence Patterns and Predictors of GLP-1 Receptor Agonist Use for Obesity Management in a Medicaid Population. Advances in Therapy. 2026. PMID: 42831955. DOI: 10.1007/s12325-026-03806-x. https://pubmed.ncbi.nlm.nih.gov/42831955/
5. Mississippi Division of Medicaid, Drug Utilization Review Board Minutes of the March 19, 2026 meeting, draft (Internet Archive capture of April 19, 2026). medicaid.ms.gov via web.archive.org. 2026. https://web.archive.org/web/20260419041241/https://medicaid.ms.gov/wp-content/uploads/2026/04/2026-3-19-DOM-DUR-BOARD-MEETING-MINUTES-DRAFT_v2.pdf
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. Eli Lilly and Company FOUNDAYO (orforglipron) tablets: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ac446c5-feba-474f-a103-23facb9b5c62
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. Mississippi Division of Medicaid Universal Preferred Drug List, effective November 1, 2026 (version 2026_17, updated October 29, 2026). medicaid.ms.gov. 2026. https://www.medicaid.ms.gov/sites/dom/files/Pharmacy/MS%20Medicaid%20PDL_November%202026_FINAL.pdf
16. Mississippi Division of Medicaid Provider Notice of Preferred Drug List Changes, effective January 1, 2027 (P&T meeting October 27, 2026). medicaid.ms.gov. 2026. https://www.medicaid.ms.gov/sites/dom/files/Pharmacy/MS-PT%20Provider%20Notice%2010272026_FINAL.pdf

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Cite as: GLP Watchdog, Nora Bissett, "Does Mississippi Medicaid Cover Wegovy and Zepbound? Coverage, Criteria and Who Stays On", published 2026-11-06, updated 2026-11-10. https://glpwatchdog.org/research/mississippi-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.