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Does Medi-Cal cover Wegovy, Zepbound or Ozempic in 2026?

Not for weight loss: since Jan 1, 2026, Medi-Cal does not cover Wegovy, Zepbound or Saxenda for weight loss in adults, according to the Medi-Cal Rx bulletin last updated Apr 6, 2026 [1]. Other uses still have a route. Wegovy can be approved for heart disease through prior authorization, and since Apr 1, 2026 it needs no prior authorization for MASH; Zepbound requests are considered for sleep apnea; Ozempic and Mounjaro stay covered for type 2 diabetes [1] [4]. Members under 21 can still have weight-loss requests reviewed for medical necessity [1].

Updated By the Wellchosen Health editorial team

Medical review: pending. A licensed clinician has not yet reviewed this page.

Medi-Cal is California's Medicaid program; its outpatient drugs are paid through Medi-Cal Rx, which decides GLP-1 coverage by the reason the drug is prescribed [1] [21].

At a glance

Under 21
Reviewed case by caseFederal EPSDT benefit for members younger than 21 [1]
State savings estimate
$790 millionEstimated General Fund savings by 2028-29, per the DHCS budget highlights [2]
Enrolled in Medi-Cal and CHIP
11.66 millionMedicaid and CHIP combined, June 2026 [9]

Medi-Cal GLP-1 rules by reason for the prescription

Medi-Cal judges each GLP-1 request by the diagnosis, not the drug's name. The same Wegovy pen can be refused for weight loss and paid for MASH. This table sorts the rules by use, as published by Medi-Cal Rx [1] [4] and checked Oct 18, 2026.

What Medi-Cal Rx covers, by use (checked Oct 18, 2026)
UseDrugMedi-Cal ruleSinceSource
Weight loss, adults 21 and olderWegovy, Zepbound, SaxendaNot covered. Zepbound and Saxenda were taken off the Contract Drugs List.Jan 1, 2026[1] [2]
Weight loss, under 21Weight-loss GLP-1sPrior authorization reviewed for medical necessity under the federal EPSDT benefitJan 1, 2026[1]
Heart disease (cardiovascular risk)WegovyPrior authorization, reviewed for medical necessityListed in the Dec 12, 2025 bulletin[1]
Obstructive sleep apneaZepboundPrior authorization considered. Because Zepbound is off the drug list, every fill needs one.Listed in the Dec 12, 2025 bulletin[1]
MASH (noncirrhotic)WegovyNo prior authorization; the claim must carry diagnosis code K76.0 and/or K75.8Apr 1, 2026[4]
Type 2 diabetesOzempic, Mounjaro, Rybelsus, Trulicity, Victoza, Byetta, BydureonOn the drug list with a type 2 diabetes diagnosis restriction (Code I)Unchanged by the 2026 cut[1]
Medi-Cal Rx does not publish how many heart or sleep apnea requests it approves. Wegovy's MASH approval covers the injection only, per the FDA label [10]. The national picture is on Medicaid GLP-1 coverage by state.

Heart disease: Wegovy with prior authorization

Wegovy's FDA label includes reducing the risk of major heart events in adults with established cardiovascular disease and obesity or overweight [10]. Medi-Cal Rx says prior authorization requests for non-weight-loss uses such as cardiovascular disease are reviewed for medical necessity [1]. The prescriber files the request and documents the heart diagnosis.

Sleep apnea: Zepbound with prior authorization

The FDA approved Zepbound on Dec 20, 2024 for moderate to severe obstructive sleep apnea in adults with obesity [13]. Medi-Cal Rx states that Zepbound requests will be considered for this use [1]. Zepbound left the Contract Drugs List on Jan 1, 2026, so a pharmacy cannot fill it on Medi-Cal without an approved request, whatever the diagnosis [1].

MASH: Wegovy without prior authorization

Since Apr 1, 2026, Wegovy prescribed for noncirrhotic MASH does not need an approved prior authorization, as long as the claim lists ICD-10 code K76.0 and/or K75.8 [4]. On the label, this use applies to Wegovy injection in adults with moderate to advanced liver fibrosis, not to the tablets [10].

Type 2 diabetes: Ozempic and Mounjaro

Ozempic, Mounjaro and five other diabetes GLP-1s remain on the Contract Drugs List with a Code I restriction to type 2 diabetes [1]. A claim without that diagnosis is rejected, and Medi-Cal Rx reviews non-weight-loss requests for these drugs for medical necessity [1]. Ozempic is not FDA-approved for weight loss [12], so a Medi-Cal Ozempic prescription written for weight alone will not be paid.

Which Medi-Cal members this covers

The rule reaches nearly every Medi-Cal member. The California Medical Association says it applies to fee-for-service Medi-Cal and to all Medi-Cal managed care plans [5]. DHCS says Medi-Cal Rx covers members of all Medi-Cal managed care plans, with exceptions only for PACE, SCAN and MRMIP [21]. That includes people whose Medi-Cal plan is Kaiser Permanente: the state's change, not a Kaiser decision, ended their weight-loss coverage on Jan 1, 2026 [1] [21]. Kaiser's commercial plans have their own rules, covered on our Kaiser Permanente GLP-1 coverage page.

Medi-Cal and CHIP together enrolled 11,659,421 Californians in June 2026, 10,396,710 of them in Medicaid alone, according to KFF's tables of federal enrollment data [9]. Local options for people paying on their own are on our pages for medical weight loss in Los Angeles, semaglutide in San Diego and weight loss in Sacramento.

What changed and when

  • Apr 6, 2026: Medi-Cal Rx announced that, effective Apr 1, 2026, Wegovy for noncirrhotic MASH no longer needs prior authorization. The same notice repeats that Wegovy is not covered for weight loss [4]. The Dec 12 bulletin was updated the same day [1].
  • Jan 16, 2026: KFF listed California with New Hampshire, Pennsylvania and South Carolina as states that eliminated Medicaid GLP-1 coverage for obesity [7].
  • Jan 9, 2026: KFF Health News reported the cut is written into the state budget law, that the state projected its cost for weight-loss GLP-1s would have reached nearly $800 million a year without the cut, and that the Department of Finance had no plans to reconsider after federal price deals [6].
  • Jan 1, 2026: Weight-loss coverage ended. Zepbound and Saxenda came off the Contract Drugs List, and prior authorizations already approved for them expired Dec 31, 2025 [1].
  • Dec 12, 2025: Medi-Cal Rx published its coverage considerations bulletin listing the heart, sleep apnea, under-21 and diabetes routes [1].
  • Dec 2, 2025: The California Medical Association told doctors the policy covers fee-for-service and all managed care plans [5].
  • Nov 14, 2025: Medi-Cal Rx told pharmacies that GLP-1 drugs, including Ozempic and Mounjaro, would no longer be eligible for coverage for weight loss from Jan 1, 2026 [3].
  • July 2025: The 2025-26 Budget Act assumed elimination of GLP-1 coverage for weight loss starting Jan 1, 2026, with estimated General Fund savings of $85 million in 2025-26, rising to $790 million by 2028-29 [2].

One source says less is covered

A Dec 2, 2025 California Medical Association summary said Wegovy, Saxenda and Zepbound would not be covered for any use from Jan 1, 2026, and that other GLP-1s would remain covered only for type 2 diabetes [5]. Medi-Cal Rx's own bulletin, dated ten days later and updated Apr 6, 2026, allows prior authorization for heart disease and sleep apnea [1]. We follow the Medi-Cal Rx bulletin because it is the program's own and the newer document.

What to do now

Ask whether a covered diagnosis applies to you

  • Heart disease and overweight or obesity: ask the prescriber to submit a Wegovy prior authorization for cardiovascular risk reduction [1] [10].
  • Moderate to severe sleep apnea with obesity: ask about a Zepbound prior authorization, and what sleep study records it needs [1] [11].
  • Noncirrhotic MASH with fibrosis: Wegovy can be filled without prior authorization when the claim carries the MASH diagnosis code [4]; on the FDA label, the MASH use is for the injection [10].
  • Type 2 diabetes: Ozempic, Mounjaro and other diabetes GLP-1s are on the drug list with that diagnosis [1].
  • Under 21: a weight-loss request can still be filed and reviewed for medical necessity [1].

If a request is denied: the state hearing

A Medi-Cal denial comes with a Notice of Action. DHCS says you must ask for a State Fair Hearing within 90 days of receiving that notice, using the request form on the back of the notice, by fax to (833) 281-0905, online, by mail to the CDSS State Hearings Division, or by phone at (800) 743-8525 [17]. A hearing can test whether a request met the rules for a covered use. Weight loss alone is outside what Medi-Cal now pays for in adults [1], so the case is strongest when the denial concerns heart disease, sleep apnea, MASH or diabetes.

If you pay yourself

Self-pay prices outside Medi-Cal, checked Oct 17, 2026
DrugMonthly priceConditionsCheckedSource
Wegovy pen, NovoCare$349All standard doses. New self-pay patients pay $199 for the first two fills of 0.25 mg or 0.5 mg, through Dec 31, 2026.Oct 17, 2026Novo Nordisk [14]
Wegovy pill, NovoCare$149 to $299$149 for 1.5 mg, $199 for 4 mg, $299 for 9 mg and 25 mgOct 17, 2026Novo Nordisk [14]
Zepbound, LillyDirect$299 to $449$299 for 2.5 mg, $399 for 5 mg, $449 for 7.5 to 15 mg when refilled within 45 days. Late refills: $499 for 7.5 mg, $699 for 10 to 15 mg.Oct 17, 2026Eli Lilly [15]
Ozempic, NovoCare$349 to $499$349 for 0.25, 0.5 or 1 mg; $499 for 2 mg. New self-pay patients pay $199 for the first two fills of 0.25 mg or 0.5 mg, through Dec 31, 2026. Approved for type 2 diabetes, not weight loss.Oct 17, 2026Novo Nordisk [16] [12]
The $25 copay cards from Lilly and Novo Nordisk need commercial insurance and exclude government program members, including Medicaid [19] [14]. NovoCare says people in government programs may pay its self-pay price [14]. Full breakdowns: Wegovy cost, Zepbound cost and the GLP-1 price tracker.

If you also have Medicare

People with Medicare Part D who meet its criteria can get Wegovy or the Zepbound KwikPen for weight management at a $50 monthly copay under the Medicare GLP-1 Bridge [18]. Our Medicare GLP-1 coverage page covers who qualifies. Commercial plans are tracked on GLP-1 insurance coverage, and Massachusetts' similar cut is explained on MassHealth GLP-1 coverage.

Safety on any GLP-1, covered or self-paid

Wegovy, Ozempic and Zepbound carry a boxed warning for thyroid C-cell tumors in rodents; they should not be used with a personal or family history of medullary thyroid carcinoma or MEN 2 [10] [20]. Stop and contact a clinician if severe stomach pain will not go away, since that can signal pancreatitis, or if you see signs of an allergic reaction [10] [20]. Low blood sugar is more likely if you also take insulin or a sulfonylurea [10]. Tell your prescriber if you are pregnant or planning to be. In an emergency, call 911.

Compare every state's Medicaid GLP-1 rules

Questions people ask

Does Medi-Cal cover Wegovy for weight loss?

No. Effective Jan 1, 2026, Wegovy is no longer eligible for Medi-Cal coverage for weight loss or weight-loss-related indications, per Medi-Cal Rx [1]. Members under 21 can have a weight-loss request reviewed for medical necessity under EPSDT [1].

Is Wegovy covered by Medi-Cal for any reason?

Yes, for uses other than weight loss. Medi-Cal Rx reviews Wegovy prior authorization requests for cardiovascular disease for medical necessity [1], and since Apr 1, 2026 it pays for Wegovy for noncirrhotic MASH without prior authorization when the claim carries code K76.0 and/or K75.8 [4].

Does Medi-Cal cover Zepbound?

Not for weight loss. Zepbound was removed from the Medi-Cal Rx Contract Drugs List on Jan 1, 2026, but Medi-Cal Rx says prior authorization requests will be considered when it is used for obstructive sleep apnea [1].

Does Medi-Cal cover Ozempic, including for weight loss?

Medi-Cal covers Ozempic for type 2 diabetes: it stays on the Contract Drugs List with a Code I type 2 diabetes restriction [1]. Ozempic is not FDA-approved for weight loss [12], and a claim without a type 2 diabetes diagnosis is rejected [1].

Does Medi-Cal cover Mounjaro?

Yes, for type 2 diabetes. Mounjaro remains on the Medi-Cal Rx Contract Drugs List with a Code I type 2 diabetes diagnosis restriction [1]. It is not covered for weight loss; Zepbound, the same drug for weight and sleep apnea, needs prior authorization and is considered only for sleep apnea [1].

Does Medi-Cal cover the Wegovy pill or semaglutide?

Medi-Cal Rx says Wegovy is not covered for weight loss [1]; its notices checked Oct 18, 2026 do not name the Wegovy tablets separately, so pill coverage for heart risk is not confirmed. Semaglutide as Ozempic or Rybelsus is covered for type 2 diabetes [1], and Wegovy is covered for noncirrhotic MASH without prior authorization since Apr 1, 2026 [4], a use the FDA label gives to the injection only [10].

Does Kaiser Medi-Cal cover Wegovy?

Kaiser members enrolled through Medi-Cal get their pharmacy benefit from Medi-Cal Rx, which covers all Medi-Cal managed care plans except PACE, SCAN and MRMIP [21], so they follow the Medi-Cal Rx rules that ended weight-loss GLP-1 coverage on Jan 1, 2026 [1]. The heart disease, sleep apnea, MASH and diabetes routes that apply to all Medi-Cal members apply to them too [1] [4].

Will Medi-Cal bring back GLP-1 coverage for weight loss?

Nothing published says so. The cut is written into California's budget law, and in January 2026 the Department of Finance said it had no plans to reconsider after federal price deals [6]. The state estimated General Fund savings of $85 million in 2025-26, rising to $790 million by 2028-29 [2].

How do I appeal a Medi-Cal GLP-1 denial?

Ask for a State Fair Hearing within 90 days of receiving the Notice of Action, using the form on the back of the notice, fax (833) 281-0905, the online request page, or the CDSS line at (800) 743-8525 [17]. Hearings fit best when the request was for a covered use such as heart disease, sleep apnea, MASH or diabetes, since adult weight loss is excluded [1].

Sources

21 cited
  1. GLP-1 Coverage Considerations (bulletin, last updated Apr 6, 2026). California DHCS, Medi-Cal Rx, Dec 12, 2025.
  2. DHCS FY 2025-26 Budget Act Highlights. California Department of Health Care Services, Jul 1, 2025.
  3. GLP-1 Coverage Considerations (November bulletin). California DHCS, Medi-Cal Rx, Nov 14, 2025.
  4. Changes to GLP-1 Drug Coverage: Wegovy. California DHCS, Medi-Cal Rx, Apr 6, 2026.
  5. GLP-1 medications for weight loss will no longer be covered by Medi-Cal. California Medical Association, Dec 2, 2025.
  6. Medi-Cal ends coverage of GLP-1s for weight loss. KFF Health News, Jan 9, 2026.
  7. Medicaid coverage of and spending on GLP-1s. KFF, Jan 16, 2026.
  8. GLP-1 changes: member notice. California DHCS, Medi-Cal Rx, Oct 18, 2026.
  9. Medicaid and CHIP monthly enrollment (June 2026 data). KFF State Health Facts, from CMS enrollment data, Oct 18, 2026.
  10. Wegovy (semaglutide) label. DailyMed, National Library of Medicine, Jun 2026.
  11. Zepbound (tirzepatide) label. DailyMed, National Library of Medicine, Aug 2026.
  12. Ozempic (semaglutide) label. DailyMed, National Library of Medicine, May 2026.
  13. FDA approves first medication for obstructive sleep apnea. US Food and Drug Administration, Dec 20, 2024.
  14. Wegovy self-pay and savings offer. Novo Nordisk (NovoCare Pharmacy), Oct 17, 2026.
  15. Zepbound on LillyDirect: self-pay prices. Eli Lilly and Company (LillyDirect), Oct 17, 2026.
  16. Ozempic self-pay prices. Novo Nordisk (NovoCare Pharmacy), Oct 17, 2026.
  17. Medi-Cal Fair Hearing. California Department of Health Care Services, Oct 18, 2026.
  18. Weight loss drugs coverage. Medicare.gov (CMS), Oct 17, 2026.
  19. Zepbound coverage and savings. Eli Lilly and Company, Oct 17, 2026.
  20. Zepbound prescribing information (217806s050). US Food and Drug Administration, Apr 2026.
  21. Medi-Cal Rx frequently asked questions. California Department of Health Care Services, Oct 18, 2026.

This page is general information, not medical advice. Talk with a licensed clinician about your own care.

Compare every state's Medicaid GLP-1 rules