NC Medicaid announces it will stop covering GLP-1s for weight management

North Carolina Medicaid announced on Sept. 5, 2025, that it would stop covering GLP-1 medications prescribed for obesity treatment, effective Oct. 1, 2025. The state pointed to "shortfalls in state funding" and noted that covering GLP-1s for obesity is an optional benefit for Medicaid programs, not a required one ^[1].

The change applies to both NC Medicaid Direct and NC Medicaid Managed Care ^[1]. More than 3.1 million North Carolinians have health coverage through Medicaid ^[1].

What changed on Oct. 1

Three drugs came off the state's Preferred Drug List (PDL) as an off-cycle change: Wegovy (semaglutide), Zepbound (tirzepatide) and Saxenda (liraglutide) ^[1]. Saxenda is no longer covered for any indication ^[1].

Wegovy and Zepbound remain available, but only through prior authorization and only for specific FDA-approved uses other than weight management. For Wegovy, that means reducing the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease who are obese, and treating noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), formerly called NASH, with moderate to advanced liver fibrosis consistent with stages F2 to F3 in adults ^[1]. For Zepbound, continued coverage applies to moderate to severe obstructive sleep apnea (OSA) in adults with obesity ^[1].

There are no changes to GLP-1 coverage for the treatment of diabetes ^[1].

The prior authorization reset

One practical detail matters a lot for people already on these drugs: prior authorizations that were in place before the change stopped being valid after Sept. 30, 2025 ^[1]. Providers have to obtain a new prior authorization for beneficiaries receiving Wegovy and Zepbound, effective Oct. 1, 2025, and requests could be submitted starting that day ^[1]. The state directed providers to review updated clinical criteria posted on the NCTracks site ^[1].

Older, non-GLP-1 weight-loss drugs were not cut. The Non-Incretin Mimetics class for obesity treatment continues to be managed through the PDL, and three products hold preferred status: diethylpropion, phendimetrazine and phentermine. Those do not require prior approval ^[1].

The state said it "remains committed to the potential of GLP-1s for the treatment of obesity," but that "at this time the lack of funding for the program prohibits continued coverage for weight management purposes" ^[1].

Why it matters for patients

For a North Carolina Medicaid beneficiary who was using Wegovy or Zepbound purely for weight management, coverage ended. That is the clearest consequence ^[1]. Whether a person can keep coverage now depends on whether they have one of the other conditions the state still pays for — diabetes, established cardiovascular disease with obesity, noncirrhotic MASH with F2 to F3 fibrosis, or moderate to severe sleep apnea with obesity — and whether their prescriber can document it under the state's new clinical criteria ^[1].

Even patients who do qualify under one of those indications were not grandfathered in. Because existing prior authorizations expired Sept. 30, 2025, a new authorization had to be filed for the prescription to be covered under the new rules ^[1]. That kind of paperwork reset can create gaps at the pharmacy counter if a refill comes due before the new approval is processed.

People who had been taking Saxenda face a harder situation: the state removed it from coverage for every indication, not just for weight loss ^[1].

The bulletin does not say how many NC Medicaid members were taking GLP-1s for obesity, how much the program was spending on them, or what the size of the budget shortfall was. Those numbers are not in the source. The bulletin also does not describe any appeals process, transition supply, or exception pathway beyond the standard prior authorization route ^[1].

North Carolina acknowledged the impact directly: "We understand that these changes may place a burden on beneficiaries, their families and on providers," the agency wrote, adding that it is "committed to working with state and federal policymakers to ensure everyone can access affordable, quality health care" ^[1].

What happens next

The key dates have already passed: the announcement came Sept. 5, 2025; old prior authorizations lapsed after Sept. 30, 2025; and the coverage change plus the new prior authorization window began Oct. 1, 2025 ^[1].

The state did not announce an end date for the change or conditions under which obesity coverage might return — it said only that funding currently prohibits it ^[1]. NC Medicaid listed the NCTracks Call Center at 1-800-688-6696 for questions ^[1].