# South Carolina Medicaid and Weight-Loss GLP-1s: What Was Dropped and What Remains By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06 Canonical page: https://glpwatchdog.org/research/south-carolina-medicaid-glp1-coverage > South Carolina covered GLP-1s for weight management for 14 months, gave up orlistat along the way, then removed them. What the state's drug lists, criteria and committee minutes now say about Wegovy, Zepbound and Ozempic, and how to appeal. ## Key points - South Carolina paid for GLP-1s for weight management from November 1, 2024 until the December 31, 2025 removal. - The November 2026 state list names no weight-loss drug; orlistat had already gone in January 2025. - Committee minutes keep Wegovy for heart risk and MASH, yet the state's criteria index has no Wegovy document. - We found no South Carolina route for Zepbound, including for sleep apnea. - Ozempic and Trulicity stay preferred for type 2 diabetes, after metformin and with a recent A1c. No. South Carolina Medicaid removed GLP-1s for obesity from its drug list on December 31, 2025, only 14 months after it began covering them on November 1, 2024.[1][2] As of November 2026 the state’s preferred drug list has no entry for Wegovy, Zepbound or Saxenda.[3] Diabetes coverage did not change, and the state’s committee was told Wegovy stays covered for uses other than obesity, such as heart risk and the liver disease MASH.[1] > **About this article.** This page reads South Carolina’s drug lists, prior authorization criteria, pharmacy manual and committee minutes as posted on November 6, 2026. The federal rule behind it is explained in [why Medicaid treats Ozempic and Wegovy differently](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy). For a state that kept a narrow weight-loss route, see [Michigan Medicaid and its BMI 40 rule](https://glpwatchdog.org/research/michigan-medicaid-glp1-coverage). ## When did South Carolina Medicaid stop covering Wegovy for weight loss? The removal date in the minutes is December 31, 2025, and health plans told members the change took effect January 1, 2026.[1][7] One plan’s member page names Wegovy and Saxenda.[7] People who check the record may notice that the list dated January 1, 2026 still shows a weight management class with Wegovy as preferred. The next posted list, from April 1, 2026, has no Wegovy at all, and neither has any list since.[4] The minutes are the state’s plain statement of intent, so we read the January list as a holdover, though the state has not said so. *South Carolina Medicaid and GLP-1s for weight management, from state documents* | Date | What changed | | --- | --- | | November 1, 2024 | Injectable GLP-1s covered for weight management, with prior authorization; the state called itself the 14th to do so[2] | | January 1, 2025 | Orlistat and other lipase inhibitors dropped for weight loss, with GLP-1 coverage given as a reason[2] | | State fiscal year 2026 | Rate-setting actuaries add about $20.6 million for the GLP-1 policy, mostly Wegovy[8] | | November 5, 2025 | Committee told GLP-1s for obesity will leave the list[1] | | December 31, 2025 | Removal date given in the minutes[1] | | April 1, 2026 onward | Posted lists show no Wegovy, Saxenda or weight class[3][4] | Federal law gives the state this choice, since states may leave weight-loss agents out of Medicaid.[12] The state’s pharmacy manual now lists “weight control products” among items not covered regardless of circumstance, and it excludes drugs used as anorexiants.[6] We found no state document giving a reason for the reversal, or a count of members affected. ## What was left after the GLP-1s were removed? Very little, and that is the unusual part of South Carolina’s story. When coverage began in 2024, the state cited it, along with low use, as a reason to stop paying for orlistat a year later.[2] When the GLP-1s left, orlistat did not come back: the November 2026 list names no weight-loss drug of any kind.[3] Since the manual also excludes anorexiants, people who want an older option such as those in [our phentermine comparison](https://glpwatchdog.org/research/phentermine-vs-a-glp1) should expect to pay for it themselves unless the plan says otherwise.[6] The list warns that classes it does not name may be handled differently by each plan, so a call can settle it.[3] ## Does South Carolina Medicaid still cover Wegovy for heart disease or MASH? The committee minutes say yes, and warn that members already taking Wegovy for those uses may need a new prior authorization.[1] [Wegovy’s label](https://glpwatchdog.org/drugs/wegovy) does carry both: lowering the risk of major heart events for adults who already have heart disease and excess weight, and treating noncirrhotic MASH with F2 to F3 fibrosis.[14] What the state has not posted is the test. Its index of prior authorization criteria lists GLP-1 diabetes criteria but no document for Wegovy, and the diabetes criteria revised October 1, 2026 name only type 2 diabetes routes.[5] Because Wegovy is off the single list, the list’s own caveat applies: fee-for-service and each plan may handle it differently.[3] A prescriber should call the plan before writing the request and ask for the criteria in writing. Our guide to [GLP-1s and fatty liver](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers what the MASH trial showed. ## Does South Carolina Medicaid cover Zepbound? We found no South Carolina document that says so. [Zepbound](https://glpwatchdog.org/drugs/zepbound) is absent from the 2026 lists we read, and the minutes’ carve-out names only Wegovy.[1][3] That leaves the sleep apnea use, which is on the label for adults with obesity, without a published route in this state.[15] It also does not amount to a stated refusal. Someone with a moderate to severe sleep apnea diagnosis can ask for a written decision and appeal it. For how this works nationally, see [how the sleep apnea approval changes the Medicaid question](https://glpwatchdog.org/research/does-medicaid-cover-zepbound). ## Does South Carolina Medicaid cover Ozempic for diabetes? Yes. Ozempic and Trulicity are the preferred injectables, while Mounjaro, generic liraglutide, exenatide, Victoza, Soliqua and Xultophy are non-preferred.[3] All of them sit under clinical criteria that require a documented type 2 diabetes diagnosis, a failed or unsuitable trial of metformin with a 90-day claims look-back, and an A1c from the past three months.[5] Non-preferred drugs also need a trial of the preferred ones or a reason they cannot be used.[5] Approval runs six months at first and a year on renewal, which asks for improved A1c or fasting glucose.[5] Trulicity is the route for children from age 10.[5] ## Does it matter which Healthy Connections plan you have? For classes on the list, no. Fee-for-service and all the plans use the same preferred and non-preferred drugs.[3][9] That is why changing plans will not bring weight-loss coverage back. For Wegovy’s other uses, the answer is less tidy, because Wegovy is no longer on the shared list and the state has not published shared criteria for it.[3][5] Members under 21 have a further argument. Federal child-health rules require Medicaid to provide necessary treatment whether or not the state plan covers it.[13] We found no South Carolina document applying that to these drugs. A family can ask for a medical necessity review by name. ## How do you appeal a denial in South Carolina? - **Plan first.** People in a managed care plan are told to use its internal appeal first.[10] Federal rules give 60 calendar days from the notice.[11] - **State hearing.** The state’s appeals page uses a 30-day window, and some notices count from the notice date, so follow the one on yours.[10] - **Keeping benefits.** You may ask for continued benefits within 10 days of the notice, though you could have to repay them if you lose.[10] - **Speed.** Standard state appeals are meant to finish within about 90 days, and you can ask for an expedited review.[10] Appeals have traction when the use is covered and the file is short of something. They have far less when the only diagnosis is obesity, because the drug is no longer in that benefit. Our walkthrough of [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) shows what to include. A prescriber should never add a diagnosis you do not have. ## What are the options if you lost coverage? Self-pay is what remains for most people. Lilly’s savings card for insured patients excludes government programs.[16] Prices in the figures we track are $349 a month for most Wegovy pen doses from Novo Nordisk, and from $299 at the starting dose up to $449 at higher doses for Lilly’s Zepbound KwikPen or vial.[16][17] Check each offer’s terms for limits on Medicaid members. The guide to the [lowest GLP-1 prices without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares them. ## Frequently asked questions ### Does South Carolina Medicaid cover Wegovy for weight loss? No. The state removed GLP-1s for obesity from its preferred drug list on December 31, 2025, after covering them from November 1, 2024. As of November 2026, Wegovy does not appear on the list. ### Does South Carolina Medicaid cover Ozempic? Yes, for type 2 diabetes. Ozempic is a preferred drug. The criteria ask for a documented diagnosis, a metformin trial or a reason it is unsuitable, and an A1c from the past three months. It is not covered for weight loss. ### Does South Carolina Medicaid cover Zepbound? We found no South Carolina document naming a route for Zepbound, including for sleep apnea, as of November 2026. It is not on the preferred drug list. A member with moderate to severe sleep apnea can ask the plan for a written decision and appeal it. ### Can I still get Wegovy for heart disease on South Carolina Medicaid? State committee minutes from November 2025 say Wegovy continues to be covered for uses other than obesity, such as cardiovascular risk and MASH, and that a new prior authorization may be needed. The state has not posted criteria for it, so ask your plan for them in writing. ### Does South Carolina Medicaid cover phentermine or orlistat? Not on the evidence we read. The state stopped covering lipase inhibitors such as orlistat for weight loss on January 1, 2025, and its pharmacy manual excludes weight control products and anorexiants. Confirm with your plan. ## References 1. South Carolina Department of Health and Human Services Pharmacy and Therapeutics Committee meeting minutes, November 5, 2025. southcarolina.fhsc.com. 2025. https://southcarolina.fhsc.com/downloads/provider/PTMinutes_20251105.pdf 2. South Carolina Department of Health and Human Services Pharmacy and Therapeutics Committee meeting minutes, November 6, 2024. southcarolina.fhsc.com. 2024. https://southcarolina.fhsc.com/downloads/provider/PTMinutes_20241106.pdf 3. South Carolina Department of Health and Human Services Single Preferred Drug List, effective November 1, 2026. southcarolina.fhsc.com. 2026. https://southcarolina.fhsc.com/downloads/provider/SCpdl_listing_20261101.pdf 4. South Carolina Department of Health and Human Services Single Preferred Drug List, effective January 1, 2026. southcarolina.fhsc.com. 2026. https://southcarolina.fhsc.com/downloads/provider/SCpdl_listing_20260101.pdf 5. South Carolina Department of Health and Human Services GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists Criteria, revised October 1, 2026. southcarolina.fhsc.com. 2026. https://southcarolina.fhsc.com/downloads/provider/SCRx_PAcriteria_GLP1s.pdf 6. South Carolina Department of Health and Human Services Pharmacy Services Provider Manual. scdhhs.gov. 2026. https://provider.scdhhs.gov/internet/pdf/manuals/pharm/Manual.pdf 7. First Choice by Select Health of South Carolina Prescription Benefits. selecthealthofsc.com. 2026. https://www.selecthealthofsc.com/member/benefits/prescription-benefits 8. Milliman for South Carolina Department of Health and Human Services SFY 2026 Medicaid Managed Care Capitation Rate Certification. scdhhs.gov. 2025. https://www.scdhhs.gov/sites/dhhs/files/documents/SFY%202026%20Medicaid%20Managed%20Care%20Certification.pdf 9. South Carolina Department of Health and Human Services Single Preferred Drug List Frequently Asked Questions, updated October 1, 2024. scdhhs.gov. 2024. https://www.scdhhs.gov/sites/dhhs/files/documents/May%202024%20Single%20PDL%20FAQs%20(updated).pdf 10. South Carolina Department of Health and Human Services File an Appeal. scdhhs.gov. 2026. https://www.scdhhs.gov/appeals/file-appeal 11. Code of Federal Regulations 42 CFR §438.402: Statutory basis and general requirements (managed care appeals). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/cfr/text/42/438.402 12. United States Code 42 U.S.C. §1396r-8: Payment for covered outpatient drugs. Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396r-8 13. United States Code 42 U.S.C. §1396d: Definitions, including early and periodic screening, diagnostic and treatment services. Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396d 14. Novo Nordisk WEGOVY (semaglutide): prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b 15. 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 16. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 17. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html --- Cite as: GLP Watchdog, Nora Bissett, "South Carolina Medicaid and Weight-Loss GLP-1s: What Was Dropped and What Remains", published 2026-11-06. https://glpwatchdog.org/research/south-carolina-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/south-carolina-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.