MassHealth ends weight-loss coverage for Wegovy, Zepbound and other obesity drugs

MassHealth, the Massachusetts Medicaid program, stopped covering medications prescribed only for weight loss on July 3, 2026, ending payment for anti-obesity drugs that include Wegovy (semaglutide) and Zepbound (tirzepatide) ^[1]. Massachusetts had been one of just 13 state Medicaid programs covering GLP-1s for obesity, according to the health news site KFF ^[2]. MassHealth said the change affects roughly 22,000 members who relied on Medicaid for weight-loss drugs and is expected to save about $15 million ^[2].

The state's pharmacy notice, Pharmacy Facts #271, lists the drugs no longer covered when used for weight loss: Wegovy (semaglutide), Zepbound (tirzepatide), Saxenda (liraglutide), Xenical (orlistat), the phentermine products Lomaira and Adipex-P, benzphetamine, diethylpropion and phendimetrazine ^[1]. Any drug used off-label for weight loss is also not payable ^[1]. The change follows anticipated forthcoming changes to MassHealth regulations, 130 CMR 406.413(B) ^[1].

Coverage continues for members with another medically accepted indication, but a new prior authorization is required. The listed indications are a body mass index above 27 kg/m² with established cardiovascular disease to reduce the risk of major adverse cardiovascular events; metabolic dysfunction-associated steatohepatitis, or MASH; and a BMI of 30 kg/m² or higher with moderate to severe obstructive sleep apnea ^[1].

Prior authorizations submitted before Feb. 17, 2026, were end-dated July 2, 2026, regardless of indication, and needed to be resubmitted ^[1]. Approvable prior authorizations for diabetes and prediabetes expire July 2, 2026, and the notice tells prescribers that members should be switched to an antidiabetic GLP-1 for coverage starting July 3 ^[1]. MassHealth lists Ozempic (semaglutide), Trulicity (dulaglutide) and Victoza (liraglutide) as preferred antidiabetic GLP-1s, and Mounjaro (tirzepatide) as preferred among GIP/GLP-1 agonists; Rybelsus (oral semaglutide) is non-preferred ^[1]. Prior authorizations for MACE, MASH or OSA are reviewed and approved for up to six months when documentation is attached, such as an apnea-hypopnea index score for OSA or a fibrosis stage for MASH; without that documentation, they were end-dated July 2, 2026 ^[1]. Requests for members under 21 are reviewed for medical necessity under Early and Periodic Screening, Diagnostic, and Treatment requirements, and a MassHealth spokesperson said medical necessity will be considered case by case ^[1][2].

MassHealth spokesperson Stacey Nee said the state has few options after last year's federal Medicaid reforms, which will reduce enrollment and cost the state funds. "Our proposed change to GLP-1 coverage for weight loss is a targeted approach to control costs, bring us in line with other states, and protect access to care as much as possible," she said ^[2].

Carolina Martinez, 33, of Chelsea, lost 80 pounds and brought her blood pressure back to normal after she started Wegovy in 2024 and later switched to Zepbound, the Boston Globe reported. She is down to her last two doses ^[2]. "We're dreading it," she said. "We don't want to go back to the way it was before" ^[2].

Why it matters for patients

Members who do not have one of the qualifying diagnoses will no longer have these drugs paid for. GLP-1s still typically cost hundreds of dollars a month, said Dr. Florencia Halperin, an endocrinologist and chief medical officer at the Boston weight loss clinic Form Health, who said patients commonly lose 15 to 20 percent of their weight on them, results comparable to bariatric surgery ^[2]. Doctors told the Globe that going without usually leads to significant weight gain within months, and that switching to cheaper, less effective drugs or paying out of pocket for smaller doses or less frequent injections would not match a full prescribed dose ^[2]. Dr. Richard Siegel, co-director of Tufts Medical Center's Diabetes and Lipid Center, said some patients have discussed getting second jobs to afford the medication ^[2].

About 1,700 Massachusetts residents under 21 were prescribed GLP-1s solely for weight loss ^[2]. "We expect that any gains that they had in disease resolution, all that will go away too," said Dr. Jason Zhang, a gastroenterologist at Boston Children's Hospital ^[2]. Eric-Paul Olsson, a psychiatric nurse practitioner, said the drugs have been an important resource for patients dealing with weight gain caused by antipsychotic medications ^[2].

In the same week, the federal Medicare program began a pilot covering some GLP-1s for Medicare Part D beneficiaries ^[2].

What happens next

The July 2, 2026, end dates for older prior authorizations have passed, and weight-loss coverage ended July 3 ^[1]. New prior authorizations for MACE, MASH or OSA can run up to six months; the notice does not describe what happens after that period ^[1]. MassHealth has not said when the underlying regulation, 130 CMR 406.413(B), will be finalized, and it has not reported how many members have applied for coverage under another diagnosis ^[1].