GLP-1 Drug Coverage Changes

Effective January 1, 2026

Health Partners Plans Medicaid would like to inform you about an important change to the Medical Assistance prescription drug benefit program effective January 1, 2026. The Pennsylvania Department of Human Services is making this change which applies to all Pennsylvania Medicaid plans, including Health Partners Plans Medicaid.

As of January 1, 2026, GLP-1 drugs for the treatment of overweight or obesity will no longer be covered unless your doctor submits a new prior authorization request. The new request must show that you have a condition for which a GLP-1 receptor remains a covered prescription drug benefit. Previously approved requests for GLP-1 drugs will end on December 31, 2025. You will not be able to refill your prescription without a new authorization.

Please make sure to speak with your doctor about this change and take the necessary steps to request a new prior authorization if needed. 

Frequently Asked Questions

Effective January 1, 2026, prior authorizations (PA) for GLP-1 drugs will no longer be approved when used for overweight or obesity only. This change is being made by the Pennsylvania Department of Human Services (DHS) and applies to all Pennsylvania Medicaid plans. GLP-1 drugs that will no longer be covered for weight loss or weight-loss indications include:

  • Wegovy®
  • Zepbound®
  • Saxenda®
  • Trulicity®
  • Ozempic®
  • Mounjaro®
  • Rybelsus®
  • Victoza®

Members under 21 years of age using a GLP-1 drug for overweight or obesity only may still be eligible for coverage. Prior authorization requests for members younger than 21 years of age will be reviewed for medical necessity according to the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

Yes, you may still be able to get a GLP-1 drug for other health conditions. Your doctor can submit a new prior authorization request showing that the drug is needed for other health problems that are considered covered prescription drug benefits. Health Partners Plans Medicaid will review the new request to determine eligibility for coverage.

If you are currently taking Ozempic, Rybelsus, Trulicity, or Victoza for type 2 diabetes, it will continue to be covered. Please talk to your doctor if you take these drugs for other health problems.

If you currently take a GLP-1 drug for weight loss only, talk to your doctor about other ways to help you lose or maintain your weight and improve your health. Options might include other non-GLP-1 drugs if appropriate, changes in your diet, increased activity and exercise, and counseling.

If you currently have an approved prior authorization for Wegovy, Zepbound, or Saxenda it will expire on December 31, 2025. This means starting January 1, 2026, you will not be able to refill your prescription without a new authorization.

If you currently have an approved prior authorization for Trulicity, Ozempic, Mounjaro, Rybelsus, Victoza, or liraglutide and are using the drug for a diagnosis other than diabetes, it will expire on December 31, 2025. This means starting January 1, 2026, you will not be able to refill your prescription without a new authorization.

Health Partners Plans Medicaid sent affected members a letter to notify them of this change. We have also notified doctors and pharmacies about this change.

If you are no longer taking a GLP-1 drug for overweight or obesity only, you do not need to do anything.