North Carolina Medicaid ends obesity coverage for Wegovy and Zepbound
North Carolina Medicaid no longer pays for Wegovy and Zepbound for weight loss, a change that affects a program covering more than 3.1 million people.
North Carolina Medicaid stopped covering GLP-1 medications for obesity on Oct. 1, 2025, after the state cited shortfalls in state funding [1]. Wegovy, Zepbound and Saxenda were removed from the program's preferred drug list, and Saxenda will no longer be covered for any indication [1].
The change applies to NC Medicaid Direct and NC Medicaid Managed Care [1]. Obesity treatment is an optional benefit for Medicaid programs, and the state said the lack of funding "prohibits continued coverage for weight management purposes" [1]. The bulletin also said NC Medicaid "remains committed to the potential of GLP-1s for the treatment of obesity" [1].
Coverage continues for other uses. GLP-1s stay covered for diabetes, for reducing the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease who are obese, for noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and for severe obstructive sleep apnea (OSA) [1]. Wegovy remains covered for the cardiovascular and MASH indications, including moderate to advanced liver fibrosis consistent with stages F2 to F3 [1]. Zepbound remains covered for moderate to severe OSA in adults with obesity [1]. There is no change to coverage of GLP-1 medications for diabetes [1].
Beneficiaries already taking Wegovy or Zepbound need a new prior authorization as of Oct. 1, and old authorizations stopped being valid after Sept. 30 [1]. Providers can submit requests beginning Oct. 1, and updated clinical criteria are posted through the state's pharmacy contractor [1]. Weight-management drugs in the class the state calls non-incretin mimetics — diethylpropion, phendimetrazine and phentermine — remain preferred and do not require prior approval [1]. More than 3.1 million North Carolinians have Medicaid coverage [1].
The Medicaid decision follows an earlier move by the North Carolina State Health Plan, which covers state employees. Its board voted to stop covering GLP-1 drugs for weight loss beginning in April, cutting access to Wegovy and Saxenda, made by Novo Nordisk, and Zepbound, made by Eli Lilly [2]. At a forum hosted by U.S. Sen. Bernie Sanders, State Treasurer Dale Folwell said the plan "had to make the awful decision to stop covering Wegovy" and that it had 23,000 Wegovy users whose prescriptions had the potential to cost nearly $170 million a year in 2024 [2]. The plan has said the cost would have risen to more than $1 billion over six years [2]. Wegovy was the medication the plan spent the most on in 2023 [2].
The two decisions have become part of a political dispute. House Speaker Tim Moore wrote to U.S. Sen. Ted Budd that Folwell was "scapegoating anti-obesity medicine coverage as the reason for the financial problems" of the plan [2]. Folwell replied that Moore had misrepresented the plan's challenges [2]. Plan staff forecast that it would be $816 million in the red by calendar year 2027 and "likely to be unable to pay bills in fall 2026" [2]. Before the GLP-1 exclusion and before higher Medicare Advantage costs, the plan projected a shortfall of more than $1.5 billion by 2027, according to April staff calculations [2].
Why it matters for patients
For North Carolinians on Medicaid, obesity is no longer a covered reason to fill a GLP-1 prescription [1]. People taking Wegovy or Zepbound for weight loss lose coverage on that basis, while those with diabetes, cardiovascular disease, MASH or OSA may still qualify if a provider obtains a new authorization [1]. Because obesity treatment is optional for Medicaid, coverage differs by state [1].
The state has not disclosed how many Medicaid beneficiaries were using these drugs for obesity or what the change is expected to save. It also has not said what alternatives or counseling it will offer, beyond continued coverage of the non-incretin weight-management drugs [1].
What happens next
New prior authorization requests for Wegovy and Zepbound can be submitted starting Oct. 1, 2025, the date the policy took effect [1]. NC Medicaid has not said when or whether obesity coverage might return [1]. For the State Health Plan, no new coverage decision has been reported since its board ended weight-loss coverage [2].
Sources
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