Does TennCare Cover Wegovy and Zepbound? Yes, for Obesity, With a 5% Renewal Test

Yes. As of November 2026, TennCare covers Wegovy and Zepbound to treat obesity with prior authorization: both are preferred drugs, for adults with a BMI above 30, or above 27 alongside a related condition, and Wegovy also for children 12 and older.^[1][2] To keep the drug after the first year, the record must show weight loss of at least 5%.^[2]

Will TennCare pay for Wegovy and Zepbound to treat obesity?

It does, which sets Tennessee apart from most Medicaid programs. Under federal law, states may leave weight-loss drugs out of Medicaid, and many do.^[6] TennCare chose the other path: starting August 1, 2025, it began paying for obesity medicines for adults and for children within each drug’s label, under prior authorization and quantity limits.^[4] Our explainer on why Medicaid coverage of Wegovy varies by state covers the federal background.

On the November 2026 list, the obesity class has two preferred GLP-1s, Wegovy injection and the Zepbound single-dose pen, and two non-preferred ones, Saxenda and generic liraglutide.^[1] Wegovy and Zepbound are each limited to four injections a month.^[2]

Who qualifies for TennCare obesity coverage?

The conditions TennCare lists as examples for the over-27 route are high blood pressure, abnormal cholesterol, diabetes, coronary heart disease, MASH and sleep apnea.^[2] Note the thresholds are written as “greater than” 30 and 27, so a BMI of exactly 30 with no related condition would not meet the first test.^[2] The criteria also rule out anyone who has had medullary thyroid cancer or MEN2, or who has a close family member with either.^[2]

For teenagers, Wegovy is the only preferred GLP-1 in the class that TennCare opens below 18, which follows the Wegovy label’s age floor of 12.^[2][7] Our review of GLP-1 drugs in teenagers covers the evidence for that age group.

What happens at renewal if the weight loss is under 5%?

TennCare’s criteria set approvals at one year unless an entry says otherwise, and the Wegovy and Zepbound obesity entries name no shorter period.^[2] At renewal the prescriber sends chart notes showing at least 5% loss from the starting weight, confirms the lifestyle work continues, and confirms no other obesity drug or GLP-1 is in use.^[2]

Someone who falls short is not cut off overnight. A note on each entry allows up to one more month so the dose can be stepped down.^[2]

Which form does the prescriber use?

Since October 2026, TennCare splits GLP-1 requests across two forms. Obesity requests go on the Weight Management Agents PA Form.^[2] Everything else, including diabetes, heart risk, sleep apnea and MASH, goes on the GLP-1 Agonists form, which tells prescribers to send obesity requests to the other form instead.^[3]

Optum Rx reviews both. Requests can be faxed to 866-434-5523, phoned in at 866-434-5524 or sent electronically through a service such as CoverMyMeds, and Optum says it answers within 24 hours.^[3] The older appetite drugs need no GLP-1 paperwork at all: phentermine, phentermine with topiramate, orlistat and several others have been preferred without prior authorization since the 2025 change.^[1][4] Our comparison of phentermine and a GLP-1 covers how those options differ.

Does TennCare cover Wegovy or Zepbound for heart disease, sleep apnea or MASH?

Yes, through the GLP-1 Agonists form, and each route has its own test.^[3]

• Heart risk (Wegovy): a BMI over 27 plus a prior heart attack, a prior stroke, or symptomatic peripheral artery disease shown by an ankle-brachial index under 0.85, a revascularization or an amputation. The patient must also be on optimized heart therapy, meaning beta-blockers, RAS inhibitors and cholesterol drugs unless they cannot be used.^[3]
• Sleep apnea (Zepbound): a BMI over 30, a sleep study showing 15 or more breathing events per hour, other causes of daytime sleepiness ruled out, and at least three months of CPAP or BiPAP use, with documented compliance, that did not work, unless the device is contraindicated.^[3]
• MASH: F2 or F3 fibrosis shown by a FibroScan, a FIB-4 above 1.3, an ELF score, MR elastography or a biopsy, with a gastroenterologist or hepatologist prescribing or consulting. The form lists Wegovy injection, Mounjaro, Victoza and generic liraglutide for this route.^[3]

The CPAP step goes beyond the Zepbound label, which approves the drug for moderate to severe sleep apnea in adults with obesity without asking for a device trial first.^[8] For MASH, the FDA approved Wegovy on an accelerated basis, and our page on GLP-1s for fatty liver disease explains the trial.^[7] Renewal on these routes needs records showing the treatment is helping.^[3]

Does TennCare cover Ozempic and Mounjaro for diabetes?

Yes, with prior authorization. Mounjaro and Ozempic injection are preferred; Trulicity, Rybelsus, Victoza and the Ozempic tablet are non-preferred.^[1] The record must confirm type 2 diabetes with a lab value such as an A1C of 6.5% or higher or a fasting glucose of 126 mg/dL or higher.^[2][3] A non-preferred drug is approved only after two preferred drugs have failed, caused side effects or cannot be used.^[3] A person with diabetes can also qualify on the obesity route, since diabetes is one of the listed conditions for the over-27 BMI test.^[2]

How do you appeal a TennCare pharmacy denial?

First read the reason. A request sent on the wrong form, or without chart notes showing the BMI or the 5% loss, is often fixed by sending it again with the record. TennCare’s pharmacy denial notices allow 60 days, counted from the date printed on the notice, to file an appeal, and say late appeals are refused; check the date on your own notice, which controls.^[5]

Members can appeal by mail to TennCare, P.O. Box 000593, Nashville, TN 37202-0593, by fax to 1-888-345-5575, or by phone at 1-800-878-3192, weekdays from 8:00 a.m. to 4:30 p.m. Central.^[5] Most appeals are decided within 90 days; an expedited appeal for an emergency is decided in about a week, and a doctor can request one with the member’s written permission.^[5] Our guide to prior authorization and appeals covers what to put in the file, and the Tennessee state page collects the same Medicaid facts in brief.