North Carolina Medicaid ends obesity coverage for Wegovy and Zepbound over budget gap

North Carolina's Medicaid program stopped paying for GLP-1 medications prescribed to treat obesity, the state health agency announced on Sept. 5, 2025. The cut took effect Oct. 1, 2025, and the agency tied it to shortfalls in state funding ^[1].

Obesity treatment is an optional benefit for Medicaid programs. The agency wrote that "at this time the lack of funding for the program prohibits continued coverage for weight management purposes," while adding that it "remains committed to the potential of GLP-1s for the treatment of obesity" ^[1]. The bulletin applies to both NC Medicaid Direct and NC Medicaid Managed Care ^[1]. About 3.1 million North Carolinians receive health coverage through Medicaid, according to the agency ^[1].

Three brand-name products lost their place on the Preferred Drug List in what the agency called an off-cycle change: Wegovy (semaglutide), Zepbound (tirzepatide) and Saxenda ^[1]. Saxenda is no longer covered for any reason ^[1]. Wegovy and Zepbound remain available only for a narrower set of conditions, with each request routed through prior authorization and clinical criteria set by the state ^[1].

Those surviving uses are:

• Wegovy, to lower the risk of cardiovascular death, heart attack and stroke in adults who have cardiovascular disease and obesity ^[1].
• Wegovy, to treat noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), the liver condition formerly called NASH, with moderate to advanced fibrosis consistent with stages F2 to F3 ^[1].
• Zepbound, to treat moderate to severe obstructive sleep apnea in adults with obesity ^[1].

Coverage for GLP-1 drugs prescribed for diabetes is unchanged ^[1].

Obesity drugs outside the incretin class stay on the Preferred Drug List and need no prior approval. They are diethylpropion, phendimetrazine and phentermine ^[1].

On the paperwork side, members taking Wegovy or Zepbound needed a fresh authorization as of Oct. 1, because approvals on file stopped being valid after Sept. 30 ^[1]. Submissions opened Oct. 1, and the state pointed providers to updated criteria published through NCTracks ^[1]. The NCTracks call center number is 1-800-688-6696 ^[1].

Why it matters for patients

What happens to a given member depends on the diagnosis behind the prescription. Someone on Wegovy or Zepbound purely for weight management loses that coverage under this change, unless the chart also supports one of the cardiovascular, MASH or sleep apnea indications the state still pays for ^[1]. Members taking a GLP-1 for diabetes fall outside the change entirely ^[1].

For people who do still qualify, the approval process restarts rather than carries over. Because September authorizations lapsed and new requests could only be filed starting Oct. 1, a member whose paperwork was not ready at that point could face a gap at the pharmacy counter ^[1].

NC Medicaid acknowledged that the shift "may place a burden on beneficiaries, their families and on providers" and said it would keep working with state and federal policymakers on access to affordable care ^[1].

How many members lose coverage under the change has not been disclosed. Neither the price members would face paying on their own nor whether other state Medicaid programs plan similar steps has been reported ^[1].

What happens next

The dates are fixed. Sept. 30, 2025, was the last day an existing Wegovy or Zepbound authorization stayed valid. Oct. 1, 2025, is when obesity coverage ended, when the three products came off the Preferred Drug List, and when providers could begin filing new authorization requests ^[1].

Whether the state would restore weight-management coverage if its budget picture improves has not been disclosed ^[1].