Does New Hampshire Medicaid Still Cover Wegovy or Zepbound? The 2026 Rules

Not anymore. Since January 1, 2026, New Hampshire Medicaid has refused to pay for Wegovy, Zepbound, Saxenda or any GLP-1 prescribed only for weight loss.^[1] As of November 2026 a prior authorization can still get them paid for type 2 diabetes, for lowering heart risk, for moderate to severe sleep apnea and for the liver disease MASH, and it still covers older weight-loss pills such as phentermine and orlistat.^[1][5]

When did New Hampshire Medicaid stop covering Wegovy and Zepbound for weight loss?

On January 1, 2026. The Division of Medicaid Services told providers on October 9, 2025 that Saxenda, Wegovy, Zepbound and other GLP-1s, generics included, would no longer be reimbursed when prescribed only for weight loss.^[1] The same notice said coverage would stay the same for people using a GLP-1 to treat type 2 diabetes, heart risk, sleep apnea or MASH, and asked prescribers to review current patients and discuss other options with them.^[1]

Federal law has always let states leave weight-loss drugs out, so the change needed no federal approval of the drug benefit itself.^[12] Our explainer on how Medicaid treats GLP-1s for diabetes and for weight covers that background. The notice applies to all New Hampshire Medicaid, and it tells providers to ask their managed care plan’s representative how each plan carries it out.^[1]

Which GLP-1 uses does New Hampshire Medicaid still cover?

What does New Hampshire require for Wegovy and heart disease?

Four sets of proof. The patient needs a baseline BMI of at least 27, established heart disease, and must not have diabetes of either type.^[2] The record must show a documented failure of at least three months on a low-calorie diet, capped at 1,600 calories a day for men and 1,200 for women, plus a regular activity plan that includes strength training to protect muscle unless another condition rules it out.^[2]

The fourth set is heart care. The patient must already be on the standard secondary-prevention medicines that fit their history: a statin at the highest tolerated dose or another cholesterol drug, blood pressure treatment, a beta blocker after a heart attack, and an anticoagulant or antiplatelet drug where indicated.^[2] The first approval runs six months; renewals run 12 and need continued diet, exercise and heart medicines with no limiting side effects.^[2] A request made only for weight is denied.^[2] The label covers adults with established heart disease and either obesity or overweight.^[13]

What does New Hampshire require for Zepbound and sleep apnea?

The sleep apnea must be moderate to severe, with an apnea-hypopnea index of 15 or more on an in-lab attended study or polysomnography.^[3] Home tests are not named. The BMI line is 27, lower than the obesity range the label refers to, and the person must not have diabetes.^[3][16] The same three-month diet failure and strength-training plan apply as on the heart route.^[3]

CPAP is a condition, not an alternative. The patient must have used positive airway pressure at least 70% of the time over the last six months and keep using it alongside the drug, unless they cannot tolerate it or the prescriber gives another reason.^[3] Approval lasts six months, and renewals of 12 months need continued PAP use, diet and exercise.^[3] Our guide to Zepbound and sleep apnea explains the trials, which tested the drug in people on and off CPAP.

What does New Hampshire require for Wegovy and MASH?

The most testing of any route. An adult must be treated by or with a gastroenterologist or liver specialist, have fibrosis shown by one of several tests, and have liver fat of at least 8% on an MRI-PDFF scan.^[4] Accepted fibrosis tests include a biopsy from the past two years, a FibroScan reading of 8.5 kPa or more with a CAP score of at least 280, magnetic resonance elastography from 2 up to 4, or an ELF score of 9 or more.^[4] The patient must be on a statin, or unable to take any statin.^[4]

Two details differ from the other routes. The biopsy option accepts fibrosis stage 1, 2 or 3, wider than the label’s F2 to F3, and the MASH criteria carry no diabetes exclusion or three-month diet requirement.^[4][13] Heavy drinking in the past year, liver cancer, other liver disease, a MELD score of 12 or more, or bariatric surgery in the past year rule a request out.^[4] Approvals run 12 months, and renewal needs MASH resolution or less fibrosis.^[4] Our page on GLP-1s in fatty liver disease covers the evidence behind the accelerated approval.

Does New Hampshire Medicaid cover any weight-loss drug now?

Yes, older ones. The state’s weight management criteria cover orlistat, phentermine and phentermine with topiramate, on the condition that the request is not for a GLP-1.^[5] Orlistat and phentermine/topiramate start at age 12, phentermine at 16, and adults qualify from a BMI of 30, or from 27 alongside a serious risk factor such as diabetes, heart disease or sleep apnea, after a documented three-month diet trial.^[5] Approval runs six months, renewal needs weight loss, and phentermine stops at nine months.^[5] Our comparison of phentermine and the GLP-1 drugs shows how much smaller the expected loss is.

Does New Hampshire Medicaid still cover Ozempic for diabetes?

Yes. The diabetes criteria require a type 2 diagnosis, use alongside diet and exercise, and an earlier trial of an oral diabetes drug, with approvals lasting a year.^[6] On the November 2026 list, Ozempic, Trulicity, Victoza and generic exenatide are preferred; Mounjaro and Rybelsus are non-preferred and need two preferred drugs to fail first.^[7]

How do you file and appeal in New Hampshire?

Fee-for-service requests use Prime’s drug-specific forms; the line is 1-866-675-7755 and the fax 1-888-603-7696.^[8] A complete form carries the dated diet record, the sleep study or liver test, and the list of heart medicines, because each is a separate yes-or-no question.

Deadlines depend on how you get Medicaid. The department’s general rule gives 30 days from the date of its decision notice to appeal, unless another rule sets a different limit, and late appeals are refused without good cause.^[9] A managed care member appeals to the plan first, within 60 days under federal rules, and then has 120 calendar days from the plan’s decision to ask the department for a fair hearing.^[11][10] Check the notice itself for the date that applies. Our guide to GLP-1 prior authorization appeals covers what to include, and the New Hampshire state page sums up the state’s rules.

What are the options for people who lost coverage?

For weight loss alone, the choices are the older covered drugs or paying cash, since manufacturer copay cards exclude Medicaid members.^[14] As of November 2026, Novo Nordisk’s self-pay price is $349 a month for most Wegovy pen doses, and the Wegovy pill begins at $149.^[15] Lilly prices self-pay Zepbound at $299 for the starting dose, $399 at 5 mg and $449 for higher doses with on-time refills.^[14] Check each program’s terms on government insurance. Our roundup of ways to pay less for a GLP-1 without coverage compares them.