Do Wisconsin and Minnesota Medicaid Cover Wegovy or Zepbound? The Two States Compared

Yes for weight loss in both states as of November 2026, with prior authorization, but they favor different drugs. Wisconsin Medicaid made Zepbound and Foundayo its preferred weight-loss drugs on July 1, 2026, and stopped approving adult Wegovy for that use.^[1] Minnesota still lists Wegovy and Saxenda as preferred, with Zepbound nonpreferred.^[8]

How do Wisconsin and Minnesota Medicaid compare?

Does Wisconsin Medicaid cover Wegovy for weight loss?

For adults, no longer. Since July 1, 2026, ForwardHealth approves the Wegovy injection only for three uses: lowering heart risk in adults with established cardiovascular disease, treating the liver disease MASH in adults, and weight management at ages 12 to 17.^[1] Wegovy tablets have one use, the heart route.^[1] An adult who wants a covered weight-loss GLP-1 in BadgerCare Plus or Wisconsin Medicaid is steered to Zepbound or the Foundayo pill.^[1][3]

Teenagers are the exception because Wegovy keeps a weight route at ages 12 to 17 whose BMI ranks in the top 5% for age and sex, a commitment to diet and activity changes, and medical records with a BMI from the past three months.^[1] Renewal requires a lower BMI than at baseline, and those requests can run up to 365 days.^[1]

What does Wisconsin require for Zepbound or Foundayo?

• BMI. 30 or more. From 27 up to 30, two listed risk factors are needed: high cholesterol, hypertension, sleep apnea, type 2 diabetes or documented cardiovascular disease.^[1]
• A recent measurement. The form asks for a BMI taken in the past three months.^[2]
• Lifestyle. The member agrees to a reduced-calorie diet and more physical activity.^[1]
• One drug at a time. ForwardHealth will not pay for two weight management agents together.^[1]

Renewal asks less than Minnesota’s does. It wants a lower BMI than at the start and adherence, with no percentage printed, and it stops at a BMI below 18.5.^[1] Under the old rules, Wisconsin limited Zepbound to two weight-loss attempts in a lifetime and 12 continuous months, followed by a six-month wait, and a state administrative law judge upheld a denial under the two-attempt rule in 2025.^[4] The June 2026 criteria do not repeat those limits, and the old handbook topic no longer appears in the online handbook’s pharmacy prior authorization chapter, but anyone who has already used two attempts should ask ForwardHealth directly whether the limit still counts against them.^[1]

The same update dropped everything else in the old class: benzphetamine, diethylpropion, orlistat, phendimetrazine, phentermine, phentermine with topiramate, Evekeo for obesity, Saxenda and Xenical.^[1] Approvals granted before July 1 last until they expire or the approved supply runs out, and Wisconsin also covers this class for dual eligibles enrolled in Part D.^[1] That is an unusual combination: the state moved to the newest drugs and stopped paying for the cheap ones, a contrast with the older pills many other programs require first.

Does Minnesota Medicaid cover Wegovy and Zepbound?

Yes, for Medical Assistance members who meet the anti-obesity criteria dated August 2026.^[6] The Uniform Preferred Drug List covers fee-for-service and managed care plans alike, and the August 4, 2026 edition puts Wegovy and Saxenda first.^[8] An adult qualifies at BMI 30, or at 27 when hypertension, high cholesterol or type 2 diabetes is present, plus a documented diet or dietitian care and more physical activity unless a health problem prevents it.^[6] For ages 12 to 17, the bar is a BMI corresponding to 30 and a weight above 60 kg.^[6]

Zepbound is on the covered list but nonpreferred, which matters. One Minnesota plan’s criteria, effective July 6, 2026, ask for trial and failure of a preferred drug, or a documented medical reason not to use one, before a nonpreferred request.^[9] Expect to show why Wegovy did not work or could not be used.

Minnesota’s renewal test is firmer than Wisconsin’s: 5% weight loss in the first approval period for adults, or a 5% drop in baseline BMI for teenagers, along with ongoing diet and activity.^[6] After 18 months, renewal also requires keeping that loss.^[6] If therapy lapses, a new trial is possible once the initial criteria are met again.^[6]

Will Minnesota stop covering weight-loss drugs?

Not so far. HF4142 would have barred Medical Assistance from paying for drugs used solely for weight loss, and a House committee laid it over on March 25, 2026.^[10][11] The House report put the cost at $12,000 per person per year and more than 12% of the state’s drug spending.^[10] DHS criteria dated August 2026 still list these drugs, which is the best evidence that the benefit outlasted that session.^[6] With budgets this tight, the question could return.

What about heart disease, MASH and sleep apnea?

These uses follow the labels, so they have their own paperwork.^[14][15] Wisconsin’s MASH route becomes demanding after the first renewal, when it asks for resolved inflammation or a fibrosis improvement on a repeat biopsy or noninvasive test.^[1] Minnesota approves these uses for up to 12 months at a time.^[7] Background on the trials sits in our guides to Zepbound for sleep apnea and GLP-1s and fatty liver.

Do these states cover Ozempic and Mounjaro for diabetes?

Yes, both. Wisconsin’s November 2026 list shows the Ozempic injection and Mounjaro pen as preferred with a diagnosis restriction, while Ozempic tablets are non-preferred.^[3] Minnesota’s August 2026 list prefers Ozempic, Trulicity and Victoza, and puts Mounjaro and Rybelsus in the nonpreferred column.^[8]

How do you appeal a denial in Wisconsin or Minnesota?

• Wisconsin. A state form gives 45 days from the action to ask for a fair hearing, and your latest notice will show the date.^[5] The old handbook said members have no appeal rights for noncovered services, so a request for a dropped drug is unlikely to succeed.^[4]
• Minnesota, fee-for-service. State law gives 30 days from written notice, or 90 days with good cause.^[12]
• Minnesota, managed care. You use the plan’s complaint process before asking for a state hearing, and federal rules give 60 days for a plan appeal.^[12][13]

Strong appeals fix a factual gap in the file, such as a missing BMI date or a documented reason the preferred drug failed. Our guide to prior authorization and appeals shows what to send, and the state Medicaid checker lets you compare other states.

What if you don't qualify?

Cash is the fallback, and Lilly’s savings card excludes government programs.^[16] In the figures we track, Novo Nordisk sells most Wegovy pen doses for $349 a month, and Lilly sells the Zepbound KwikPen or vial from $299 at the starting dose up to $449 at higher doses.^[16][17] Check each offer’s terms for Medicaid members first. The guide to the lowest GLP-1 prices without insurance compares them, and our national page on Medicaid and Zepbound shows how far these two states sit from most others.