# Does Wyoming Medicaid Cover Wegovy or Zepbound? The Sleep Apnea, MASH and Heart Routes By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-07 Canonical page: https://glpwatchdog.org/research/wyoming-medicaid-glp1-coverage > Wyoming Medicaid has no weight-loss route for Wegovy or Zepbound. Its June 2026 drug list and criteria chart cover Zepbound in sleep apnea, Wegovy in MASH, and Wegovy for adults with past heart events, with short criteria and no CPAP step. The Ozempic pen is non-preferred. ## Key points - No weight-loss route is posted: the manual excludes anorexiant products and the drug list names Wegovy and Zepbound only for other uses. - Zepbound for sleep apnea needs an adult with obesity and an AHI above 15 on a recent sleep study, with no CPAP step. - Wegovy for MASH needs only the diagnosis; the heart route asks for a BMI from 27 up and a past heart attack, stroke or artery disease. - The Ozempic pen is non-preferred for diabetes on every 2026 list, while the Ozempic tablet is preferred. - A denial must be taken to reconsideration within 20 business days before any hearing. No. As of November 2026, Wyoming Medicaid has no route for Wegovy or Zepbound as weight-loss drugs: its pharmacy manual excludes anorexiant products from every Medicaid plan, and its drug list names the two medicines only for other conditions.[1][3] With prior authorization it covers three narrower uses: Zepbound when an adult with obesity has moderate to severe sleep apnea, Wegovy for the liver disease MASH, and Wegovy for adults with a BMI of 27 or more and a past heart attack, stroke or artery disease.[1][2] > **About this article.** This page reads Wyoming Medicaid’s preferred drug list and clinical criteria chart dated June 8, 2026, and its pharmacy manual dated October 19, 2026, as posted on November 7, 2026. The state posts a new drug list several times a year, so check the current file before filing. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker). ## Will Wyoming Medicaid pay for Wegovy or Zepbound to lose weight? We found no way to get them covered for weight alone. The manual’s list of drugs excluded from all Medicaid plans opens with anorexiant products, and the drug list puts Wegovy and Zepbound only under sleep apnea, MASH and heart-risk criteria.[1][2][3] Under federal Medicaid law, a state may leave out drugs used for weight loss, and Wyoming takes that option.[7] Our page on [which states’ Medicaid programs pay for Zepbound](https://glpwatchdog.org/research/does-medicaid-cover-zepbound) sets Wyoming beside the rest. Wyoming runs its drug benefit directly, with OptumRx handling claims and prior authorization. That arrangement took over on April 15, 2026, when claims and requests moved to new OptumRx systems.[4] ## When does Wyoming Medicaid cover a GLP-1? In four situations. Wyoming’s written criteria are short, often a single sentence, which leaves fewer boxes to tick than in most states.[1][2] *Wyoming Medicaid GLP-1 rules by use, from the drug list and clinical criteria chart dated June 8, 2026* | Use | Drug | Status | What the criteria ask for | | --- | --- | --- | --- | | Weight loss alone | Wegovy, Zepbound | No route | None posted | | Type 2 diabetes | Ozempic tablets, Rybelsus, Trulicity, Victoza, exenatide | Preferred, with criteria | 90 days of metformin in the past year, waived with heart disease or risk factors | | Type 2 diabetes, other brands | Ozempic pen, Mounjaro, generic liraglutide | Non-preferred | A 90-day failed trial of a preferred drug | | Moderate to severe sleep apnea | Zepbound | Preferred, with criteria | Adult with obesity; AHI above 15 on a sleep study from the past 12 months | | MASH | Wegovy, Wegovy HD | Preferred, with criteria | A MASH diagnosis | | Heart attack, stroke or artery disease | Wegovy | Clinical criteria | BMI 27+; heart attack, stroke or PAD in the past | ## Does Wyoming Medicaid cover Zepbound for sleep apnea? Yes. The person must be an adult with obesity and moderate to severe sleep apnea, with an AHI (apnea-hypopnea index) above 15 on a sleep study from the past 12 months.[1] The criteria say “greater than 15,” so a score of exactly 15 does not meet the letter of the rule even though it is the usual floor for moderate disease. A prescriber whose patient scores right at the line should expect questions. The text asks for nothing else at the start: no CPAP trial, no sleep specialist, no stated BMI number beyond obesity, and no diabetes exclusion.[1][2] That is close to the label, which covers moderate to severe sleep apnea in adults with obesity.[8] Neighboring Montana is much stricter and turns Zepbound down if CPAP alone brings the AHI under 15, as our [Montana Medicaid guide](https://glpwatchdog.org/research/montana-medicaid-glp1-coverage) explains. Renewals carry the weight. A new authorization is needed at six months showing at least 5% weight loss, and again at 12 months with a repeat sleep study showing the apnea has improved; later approvals need continued gains in weight and overall health.[1][2] Booking the follow-up sleep study early avoids a gap in supply. The trials behind the indication are covered in our guide to [Zepbound for obstructive sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea). ## Will Wyoming Medicaid cover Wegovy for fatty liver disease (MASH)? Yes, and the requirement is a single line: Wegovy injections need a diagnosis of MASH.[1] Both the standard Wegovy pens and Wegovy HD sit in the preferred column for MASH, and Rezdiffra is non-preferred.[1] The change took effect with the January 1, 2026 drug list.[5] Wyoming’s text names no fibrosis stage, test or specialist.[1] The label is narrower than that: it covers noncirrhotic MASH with moderate to advanced fibrosis, stages F2 to F3, under accelerated approval.[9] A file that shows the stage, from a biopsy, a FibroScan or a similar test, matches the label and is harder to question. Our page on [GLP-1 drugs for MASH](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers what the trial showed. ## Does Wyoming Medicaid cover Wegovy for heart disease? Yes. The drug list points to the state’s clinical criteria chart for the heart route, and the June 8, 2026 chart asks for a BMI from 27 up plus heart or vessel disease, which it defines as a past heart attack, a past stroke or peripheral artery disease.[1][2] The chart sets no diabetes exclusion, no A1C limit and no specialist, unlike several nearby states. Nebraska, for example, limits its heart route to adults without diabetes. Those terms track the label, which covers adults with established heart disease and either obesity or overweight.[9] The January 2026 drug list notice described Wegovy as preferred with clinical criteria that match its approved uses.[5] ## What does Wyoming require for Ozempic and other diabetes GLP-1s? A type 2 diabetes patient on Wyoming Medicaid usually needs a 90-day supply of metformin in the past year first; the step is dropped when the patient has atherosclerotic heart disease or risk factors for it.[1] The preferred drugs are the Ozempic tablet, Rybelsus, Trulicity, brand Victoza and exenatide.[1] The Ozempic pen is the surprise. It sits in the non-preferred column, as it has on every 2026 list, so it needs a 90-day failed trial of a preferred drug first; Mounjaro is non-preferred too.[1] The Ozempic tablet moved into the preferred column on the June 2026 list.[1] ## How does a prescriber file, and how do you appeal? Wyoming has no GLP-1 form; requests go on the general prior authorization forms listed on the state site.[12] The OptumRx line for prior authorization, pharmacy appeals and clinical calls is 877-207-1126, and the fax, open around the clock, is 866-964-3472.[3][6] If a request is denied, the patient or prescriber can ask for reconsideration within 20 business days of receiving the denial, sending any added records to OptumRx.[3] Only after the state’s pharmacy program rules on that request can the patient ask for an administrative hearing, and missing the reconsideration window closes that door.[3] Our walkthrough of [how to appeal a GLP-1 denial](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to send, and the [Wyoming state page](https://glpwatchdog.org/states/wyoming) collects the state’s facts in brief. ## What can you do if Wyoming Medicaid will not pay? Manufacturer savings cards will not help, since Lilly’s terms rule out people on Medicaid and other public coverage.[10] Cash prices in the figures we track are $349 a month for most Wegovy pen doses through Novo Nordisk, and $299 at the starting dose, $399 at 5 mg and $449 at higher doses refilled on time for Lilly’s Zepbound.[10][11] Read each program’s terms on government coverage before you enroll. Our roundup of [the cheapest ways to pay for a GLP-1 without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares the options. ## Frequently asked questions ### Does Wyoming Medicaid cover Wegovy for weight loss? No. As of November 2026 Wyoming Medicaid posts no weight-loss route for Wegovy. It covers Wegovy with prior authorization for MASH, and for adults with a BMI from 27 up whose history includes a heart attack, a stroke or peripheral artery disease. ### Does Wyoming Medicaid cover Zepbound? Only for sleep apnea. An adult with obesity and moderate to severe obstructive sleep apnea, with an AHI above 15 on a sleep study from the past year, can be approved. Renewal at six months needs at least 5% weight loss, and at 12 months a repeat sleep study showing improvement. ### Does Wyoming Medicaid require CPAP before Zepbound? No. The June 2026 criteria ask for a sleep apnea diagnosis, obesity, adult age and an AHI above 15 on a recent sleep study. They do not mention CPAP or a sleep specialist. ### Is Ozempic covered by Wyoming Medicaid? For type 2 diabetes, yes, but the Ozempic pen is non-preferred on the June 2026 list and needs a failed 90-day trial of a preferred drug such as Trulicity, Victoza or Rybelsus. The Ozempic tablet is on the preferred list. ### How do I appeal a Wyoming Medicaid prior authorization denial? Ask for reconsideration within 20 business days of receiving the denial notice, with any new records, through OptumRx. An administrative hearing is available only after that reconsideration decision, and a late reconsideration request rules out the hearing. ## References 1. Wyoming Department of Health, Wyoming Medicaid Preferred Drug List (PDL), June 8, 2026. wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicaid/wy/pdl-060826.pdf 2. Wyoming Department of Health, Wyoming Medicaid Additional Therapeutic Classes with Clinical Criteria, last updated June 8, 2026. wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicaid/wy/atcc-060826.pdf 3. Wyoming Department of Health, Division of Healthcare Financing Pharmacy Covered Services & Limitations Module, draft revision 28, October 19, 2026. wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicare/wy/wy-provider-manual-100126.pdf 4. Wyoming Medicaid Pharmacy Program Pharmacy newsletter: cutover to OptumRx systems (April 22, 2026). wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicaid/wy/medicaid-newsletter-post-go-live.pdf 5. Wyoming Medicaid Pharmacy Program Pharmacy newsletter: preferred drug list changes effective January 1, 2026. wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicaid/wy/medicaid-newsletter-010126.pdf 6. Wyoming Medicaid Pharmacy Services Program Prior Authorization Request Form (miscellaneous). wymedicaid.org. 2026. https://www.wymedicaid.org/content/dam/ffs-medicare/wy/pa-forms/wyoming-medicaid-miscellaneous-pa-form.pdf 7. 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 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 9. 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 10. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 11. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html 12. Wyoming Medicaid PA forms and related information. wymedicaid.org. 2026. https://www.wymedicaid.org/content/wymedicaid/en/pa-pdl/pa-forms-related-info.html --- Cite as: GLP Watchdog, Nora Bissett, "Does Wyoming Medicaid Cover Wegovy or Zepbound? The Sleep Apnea, MASH and Heart Routes", published 2026-11-07. https://glpwatchdog.org/research/wyoming-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/wyoming-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.