# Does TennCare Cover Wegovy and Zepbound? Yes, for Obesity, With a 5% Renewal Test By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-07 Canonical page: https://glpwatchdog.org/research/tennessee-tenncare-glp1-coverage > TennCare has covered obesity drugs since August 2025. Its current criteria make Wegovy and the Zepbound pen preferred, open Wegovy to teens, require 5% weight loss to renew, and send heart, sleep apnea and MASH requests to a separate form with its own tests. ## Key points - TennCare has paid for obesity drugs since August 1, 2025, with prior authorization. - Wegovy and the Zepbound single-dose pen are the preferred GLP-1s in the obesity class; Saxenda is not. - Teens 12 and older can get Wegovy with a BMI at the 95th percentile or higher. - Keeping the drug past the first year takes chart notes showing at least 5% weight loss. - Zepbound for sleep apnea needs three months of CPAP or BiPAP that did not work. 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] > **About this article.** This page reads TennCare’s preferred drug list and clinical criteria, both dated November 2, 2026, the GLP-1 request form revised in October 2026, and the state’s August 2025 notice on obesity drugs, as they stood on November 7, 2026. We could not open the separate weight management request form or the state rule text. TennCare updates its lists often, so check the current files before filing. To compare every state, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker). ## 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](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) 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? *TennCare obesity criteria for Wegovy and Zepbound, from the clinical criteria dated November 2, 2026* | Requirement | Wegovy injection | Zepbound single-dose pen | | --- | --- | --- | | Minimum age | 12 (the label minimum) | 18 | | Adults | BMI above 30, or above 27 plus a weight-related condition | BMI above 30, or above 27 plus a weight-related condition | | Under 18 | BMI in the top 5% for their age and sex (the 95th percentile or higher) | Not applicable | | Lifestyle | Prescriber attests to diet, activity or a structured program | Same | | Not allowed with | Other obesity drugs, DPP-4 drugs, a second GLP-1 | Same | | Renewal | Weight loss of at least 5% (adults) or more than 5% of baseline BMI-for-age (under 18) | Weight loss of at least 5% | 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](https://glpwatchdog.org/research/glp1-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](https://glpwatchdog.org/research/phentermine-vs-a-glp1) 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](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) 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](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to put in the file, and the [Tennessee state page](https://glpwatchdog.org/states/tennessee) collects the same Medicaid facts in brief. ## Frequently asked questions ### Does TennCare cover Wegovy for weight loss? Yes. As of November 2026, Wegovy injection is a preferred TennCare drug for obesity with prior authorization. Adults qualify with a BMI above 30, or above 27 plus a condition tied to weight, and patients 12 to 17 need a BMI in the top 5% for their age and sex (the 95th percentile or higher). ### Does TennCare cover Zepbound? Yes. The Zepbound single-dose pen is preferred for obesity in adults 18 and older with the same BMI tests as Wegovy. It is also covered for sleep apnea with a BMI over 30, a sleep study showing 15 or more events per hour and three months of CPAP that did not work. The KwikPen is non-preferred. ### What weight loss does TennCare require to renew Wegovy or Zepbound? At renewal, adults need chart notes showing a loss of at least 5% of their starting weight. Patients under 18 need a drop of more than 5% in BMI-for-age. Someone who does not meet the test may be approved for up to one more month to taper off. ### Which form is used for Wegovy for obesity in Tennessee? Obesity requests use TennCare's Weight Management Agents PA Form. Requests for diabetes, heart risk reduction, sleep apnea and MASH use the separate GLP-1 Agonists form revised in October 2026. Both go to Optum Rx, which says it responds within 24 hours. ### What is the deadline to appeal a TennCare drug denial? TennCare's pharmacy denial notices allow 60 days, counted from the date printed on the notice. Appeals can be mailed, faxed to 1-888-345-5575 or made by phone at 1-800-878-3192. Check the date printed on your own notice, because that is the deadline that applies. ## References 1. Division of TennCare TennCare Preferred Drug List (PDL), effective November 2, 2026. Optum Rx TennCare pharmacy program. 2026. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/Tenncare/Tenncare-PDL.pdf 2. Division of TennCare Clinical Criteria, Step Therapy, and Quantity Limits for TennCare Preferred Drug List, November 2, 2026. Optum Rx TennCare pharmacy program. 2026. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/Tenncare/Criteria-PDL.pdf 3. Division of TennCare; Optum Rx GLP-1 Agonists Prior Authorization Form, revision 10/2026. Optum Rx TennCare pharmacy program. 2026. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/Tenncare/GLP-1-Agonists-PA-Form.pdf 4. Division of TennCare Provider Notice: TennCare Pharmacy Coverage of Obesity Management Agents, effective August 1, 2025. Optum Rx TennCare pharmacy program. 2025. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/Tenncare/Provider-Notice-Obesity-Management-Agents-08-01-25.pdf 5. TennCare Pharmacy Program Member pharmacy denial notice and appeal instructions (PBM 3 NCov, revised April 1, 2021). Optum Rx TennCare pharmacy program. 2021. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/Tenncare/pharmacist/patient-forms/Tamper%20Resistant%20Denial%20Notice.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. 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 8. 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 --- Cite as: GLP Watchdog, Nora Bissett, "Does TennCare Cover Wegovy and Zepbound? Yes, for Obesity, With a 5% Renewal Test", published 2026-11-07. https://glpwatchdog.org/research/tennessee-tenncare-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/tennessee-tenncare-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.