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

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

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

> On January 1, 2026, New Hampshire Medicaid dropped GLP-1s prescribed only to lose weight. Prior authorization still opens Wegovy for heart disease or fatty liver and Zepbound for apnea, along with older weight-loss pills. The diet, CPAP and liver test rules, and appeals.

## Key points

- From January 1, 2026, New Hampshire Medicaid stopped paying for any GLP-1 prescribed only for weight loss.
- Wegovy for heart risk needs a BMI of 27, a failed three-month diet, heart-prevention drugs and no diabetes.
- Zepbound for sleep apnea needs an in-lab AHI of 15 or more and six months of PAP use at least 70% of the time.
- Wegovy for MASH needs a GI or liver specialist, an MRI liver-fat scan of 8% or more and a statin, with no diabetes bar.
- Orlistat, phentermine and phentermine/topiramate remain covered with prior authorization.

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]

> **About this article.** This page reads the state’s October 9, 2025 provider notice, the fee-for-service criteria and forms posted by Prime Therapeutics, the November 1, 2026 drug list and the state’s hearing rules, as they stood on November 7, 2026. The health department’s own website could not be opened, so we could not read the managed care plans’ GLP-1 forms. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker).

## 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](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) 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?

*New Hampshire Medicaid GLP-1 routes, from Prime Therapeutics fee-for-service criteria (October 2025, diabetes criteria May 2026) and the November 1, 2026 drug list*

| Use | Drug | Main requirements | Approval |
| --- | --- | --- | --- |
| Weight loss alone | Wegovy, Zepbound, Saxenda | Not covered since January 1, 2026 | None |
| Type 2 diabetes | Ozempic, Trulicity, Victoza, exenatide preferred; Mounjaro, Rybelsus non-preferred | Diabetes diagnosis; trial of an oral diabetes drug; 2 preferred failures for non-preferred | 1 year |
| Heart attack and stroke risk | Wegovy | BMI 27+; established heart disease; 3-month failed low-calorie diet; strength training; heart-prevention drugs; no diabetes | 6 months, then 12 |
| Moderate to severe sleep apnea | Zepbound | BMI 27+; AHI 15+ on an in-lab study; PAP used 70%+ for 6 months; 3-month diet; no diabetes | 6 months, then 12 |
| MASH with fibrosis | Wegovy (or Rezdiffra) | Age 18+; GI or liver specialist; fibrosis test; MRI liver fat 8%+; statin unless not tolerated | 12 months, then 12 |

## 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](https://glpwatchdog.org/research/zepbound-for-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](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) 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](https://glpwatchdog.org/research/phentermine-vs-a-glp1) 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](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to include, and the [New Hampshire state page](https://glpwatchdog.org/states/new-hampshire) 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](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them.

## Frequently asked questions

### Does New Hampshire Medicaid cover Wegovy for weight loss?

No. Since January 1, 2026, New Hampshire Medicaid has not paid for Wegovy, Zepbound, Saxenda or any GLP-1 prescribed only for weight loss. Wegovy can still be approved with prior authorization to lower heart risk or to treat MASH.

### Does New Hampshire Medicaid cover Zepbound for sleep apnea?

Yes, with prior authorization. The patient needs an AHI of 15 or more on an in-lab sleep study, a BMI of at least 27, no diabetes, a failed three-month low-calorie diet, strength training, and PAP use at least 70% of the time over the past six months, continuing with the drug.

### Why did New Hampshire Medicaid stop covering GLP-1s for weight loss?

The October 9, 2025 provider notice announced the change but gave no reason. It ended coverage for GLP-1s prescribed solely for weight loss from January 1, 2026, and kept coverage for diabetes, heart risk, sleep apnea and MASH.

### What weight-loss drugs does New Hampshire Medicaid still cover?

Older drugs that are not GLP-1s: orlistat, phentermine and phentermine with topiramate, each with prior authorization. Adults qualify from a BMI of 30, or from 27 with a serious risk factor, plus a documented three-month diet trial. Phentermine cannot be approved past nine months.

### What is the deadline to appeal a New Hampshire Medicaid denial?

The department's general rule allows 30 days from the date of its decision notice unless another rule sets a different limit. Managed care members appeal to their plan first, then have 120 calendar days from the plan's decision to request a state fair hearing.

## References

1. New Hampshire Department of Health and Human Services, Division of Medicaid Services Change in Medicaid Coverage for GLP-1 Medications (provider notice, October 9, 2025). nh.primetherapeutics.com. 2025. https://nh.primetherapeutics.com/documents/51139/51630/Notification%2010.09.2025%20-%20GLP-1%20Coverage%20Change/218c7285-7968-9484-a244-859e0741eeba
2. New Hampshire Medicaid Fee-for-Service Program Major Adverse Cardiovascular Events (MACE) - Wegovy Criteria, approved October 1, 2025. nh.primetherapeutics.com. 2025. https://nh.primetherapeutics.com/documents/51139/51621/MACE-Wegovy%20Criteria/8f8795ad-a3ba-a80c-3b8a-b2eaef94d7af
3. New Hampshire Medicaid Fee-for-Service Program Obstructive Sleep Apnea (OSA) - Zepbound Criteria, approved October 1, 2025. nh.primetherapeutics.com. 2025. https://nh.primetherapeutics.com/documents/51139/51621/OSA-Zepbound%20Criteria/e0959ae6-9462-96ed-f65f-513497f0cd3c
4. New Hampshire Medicaid Fee-for-Service Program MASH (metabolic dysfunction-associated steatohepatitis) Criteria, approved October 1, 2025. nh.primetherapeutics.com. 2025. https://nh.primetherapeutics.com/documents/51139/51621/MASH%20Criteria/4a490bb0-6ec4-9e4c-09a5-2c257b186da2
5. New Hampshire Medicaid Fee-for-Service Program Weight Management Criteria, approved October 1, 2025. nh.primetherapeutics.com. 2025. https://nh.primetherapeutics.com/documents/51139/51621/Weight%20Management%20Criteria/1d05102e-f296-fc44-b033-4cab63927518
6. New Hampshire Medicaid Fee-for-Service Program GLP-1 Receptor Agonist Criteria, approved May 12, 2026. nh.primetherapeutics.com. 2026. https://nh.primetherapeutics.com/documents/51139/51621/GLP-1%20Receptor%20Agonist%20Criteria/9105e0b5-0a2e-48dc-d176-594ab9907de5
7. New Hampshire Department of Health and Human Services Fee-for-Service Medicaid Preferred Drug List, effective November 1, 2026. nh.primetherapeutics.com. 2026. https://nh.primetherapeutics.com/documents/51139/51633/Preferred%20Drug%20List%20-%2011.1.2026/6e9150d6-93be-3f04-faba-ccdecc8899d3
8. New Hampshire Medicaid Fee-for-Service Program Prior Authorization Drug Approval Form: MACE - Wegovy. nh.primetherapeutics.com. 2026. https://nh.primetherapeutics.com/documents/51139/51627/MACE-Wegovy%20PA%20Form/859941d4-7e5f-5d84-2fca-087c8aeb68de
9. State of New Hampshire N.H. Admin. Code He-C 201.03: Time Limit for Appeals. New Hampshire General Court, Administrative Rules. 2026. https://www.gencourt.state.nh.us/rules/state_agencies/he-c200.html
10. State of New Hampshire N.H. Admin. Code He-W 506.09: Department Fair Hearing Process (managed care). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-W-506.09
11. Code of Federal Regulations 42 CFR 438.402: General requirements (managed care grievances and appeals). eCFR. 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-F/section-438.402
12. 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
13. 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
14. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings
15. Novo Nordisk Wegovy savings offer and self-pay pricing. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html
16. 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

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Cite as: GLP Watchdog, Nora Bissett, "Does New Hampshire Medicaid Still Cover Wegovy or Zepbound? The 2026 Rules", published 2026-11-07. https://glpwatchdog.org/research/new-hampshire-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.