Does Medi-Cal Cover GLP-1 in California? Drugs, Appeals, Alternatives

Medi-Cal covers GLP-1 drugs in California only for specific medical conditions, not for weight loss. Since January 1, 2026, adults 21 and older enrolled in Medi-Cal cannot get Wegovy, Zepbound, or Saxenda through the program at all, and drugs like Ozempic, Mounjaro, and Trulicity are covered only when prescribed for type 2 diabetes or another approved condition. Members under 21 can still receive GLP-1s for weight loss with prior authorization.¹

Which GLP-1 Drugs Medi-Cal Still Covers

Seven GLP-1 medications remain on the Medi-Cal Rx Contract Drugs List, but a claim will only go through if the diagnosis code indicates type 2 diabetes:

Ozempic
Rybelsus
Mounjaro
Victoza
Byetta
Bydureon
Trulicity

If your prescriber believes you need one of these for a different medical reason, they can submit a prior authorization request, which Medi-Cal reviews for medical necessity on a case-by-case basis.²

Which GLP-1 Drugs Medi-Cal No Longer Covers

Three drugs used primarily for chronic weight management were removed from the formulary entirely:

Wegovy (semaglutide)
Zepbound (tirzepatide)
Saxenda (liraglutide)

Pharmacies now receive an automatic denial when they try to fill any of these prescriptions, regardless of the diagnosis code. Every prior authorization that had previously been approved for weight loss expired on December 31, 2025. The rule applies to Medi-Cal fee-for-service and every Medi-Cal managed care plan, including L.A. Care, Health Net, and Kaiser. No plan offers separate or supplemental coverage.³

Non-Diabetes Conditions That Can Still Qualify

Even the drugs pulled from the formulary can be approved through prior authorization for certain non-weight-loss uses.

Wegovy may be approved for noncirrhotic metabolic dysfunction-associated steatohepatitis (a form of fatty liver disease known as MASH) or for cardiovascular disease. As of April 2026, Wegovy for MASH no longer requires prior authorization; the prescriber only needs to include the correct diagnosis code.⁴

Zepbound may be approved for obstructive sleep apnea with prior authorization.⁵

Medi-Cal Rx also continues to cover GLP-1 drugs for other FDA-approved uses such as atherosclerotic cardiovascular disease and chronic kidney disease, subject to prior authorization and medical necessity review.¹

Members Under 21

The weight-loss exclusion doesn’t apply to Medi-Cal members younger than 21. Under federal law, state Medicaid programs must provide comprehensive benefits to children and young adults through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. California has confirmed that GLP-1 drugs for weight loss stay available to this age group when a prior authorization request is submitted and approved.⁶

How To Appeal a Denial

If you receive a Notice of Action denying coverage for a GLP-1 drug, you can request a State Hearing through the California Department of Social Services. You have 90 days from the notice date to file. Requests can be submitted by:

Phone: 1-800-743-8525 or 1-855-795-0634
Fax: 1-833-281-0905
Mail or the online CDSS hearing-request portal

Members who were already taking a GLP-1 drug before January 1, 2026, have an extra protection. File your hearing request within 10 days of the denial notice and you can ask for “aid paid pending,” which keeps the medication going while the appeal is decided. That continued coverage lasts until the hearing decision, the expiration of the existing prior authorization, or the withdrawal of the appeal, whichever comes first.⁷

Talking to Your Provider About Alternatives

The Department of Health Care Services has advised providers to work with patients who lost coverage on individualized care plans. Those plans may involve transitioning to a different treatment, gradually weaning off the medication, or shifting to non-drug approaches like dietary changes, increased physical activity, and counseling.¹ Obesity specialists cited by KFF Health News have questioned whether those alternatives are adequate, noting that weight regain is common after stopping GLP-1 drugs.⁸

Paying Out of Pocket

The FDA approved a pill version of Wegovy in December 2025. Cash prices for the oral tablet start at around $149 per month for the lowest dose. Manufacturer savings programs are not available to anyone enrolled in a government insurance program like Medi-Cal.⁹

Other Insurance in California

The Medi-Cal exclusion doesn’t reach employer-based coverage or Covered California marketplace plans. All carriers offering 2026 Covered California plans provide some GLP-1 coverage for obesity, though the requirements tend to be restrictive. Nearly all limit coverage to enrollees with a BMI of 40 or above, require documentation of a diet and exercise program lasting three to nine months, and demand proof that those measures alone didn’t produce weight loss. Prior authorization is standard.¹⁰

If you’re on Medicare rather than Medi-Cal, a separate temporary federal program called the Medicare GLP-1 Bridge began July 1, 2026, offering Wegovy and Zepbound for weight reduction at a $50 monthly copay through the end of that year, with eligibility based on BMI and underlying conditions.¹¹

Why California Made the Change

Cost drove the decision. Medi-Cal spending on Ozempic and Wegovy alone reached roughly $733 million in 2023. Wegovy prescriptions through the program jumped from 15,000 in 2022 to 181,000 in 2023, and Ozempic prescriptions rose from 178,000 to 480,000 in the same period.¹² Governor Newsom’s administration estimated that keeping the coverage would cost $85 million in fiscal year 2025–26 and grow to $680 million annually by 2028–29.¹³ Federal law does not require state Medicaid programs to cover weight-loss drugs, and California had previously included them as an optional benefit. The elimination was codified in the 2025–26 Budget Act, and similar cuts took effect at the start of 2026 in New Hampshire, Pennsylvania, and South Carolina.⁸

1
Medi-Cal Rx (DHCS). Important Update: GLP-1s for Weight Loss Not a Covered Benefit
2
Medi-Cal Rx (DHCS). Changes to Medi-Cal Rx Effective January 2026
3
California Medical Association. GLP-1 Medications for Weight Loss Will No Longer Be Covered by Medi-Cal
4
California Pharmacists Association. Updates to the Medi-Cal Rx Contract Drugs List Regarding GLP-1s
5
Medi-Cal Rx (DHCS). GLP-1 Coverage Considerations
6
Medi-Cal Rx (DHCS). GLP-1 Changes: Information for Members
7
Medi-Cal Rx (DHCS). GLP-1 Drugs: Frequently Asked Questions for Members
8
KFF Health News. California Medi-Cal GLP-1 Weight Loss Drugs Coverage
9
Ro. Wegovy Pill Cost
10
Becker’s Payer Issues. GLP-1 Coverage Under ACA Plans
11
Medicare.gov. Weight Loss Drugs Coverage
12
CalMatters. Medi-Cal Coverage of Weight Loss Drugs
13
CalMatters. Weight Loss Drugs and Medi-Cal