South Carolina Medicaid does not cover Wegovy for weight loss. Effective January 1, 2026, the state Department of Health and Human Services removed Wegovy and Saxenda from its preferred drug list for obesity treatment, ending a coverage policy that had been in place for barely a year.1SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity Two carve-outs matter here: SC Medicaid still pays for GLP-1 medications when they are prescribed to manage Type 2 diabetes, and bariatric surgery remains a covered benefit for members who meet medical necessity criteria.2Select Health of SC. Prescription Benefits
Why the State Dropped Coverage
The decision was driven by cost. In the fiscal year before the cutoff, South Carolina spent $2.3 million in state funds and $5.5 million in federal funds reimbursing weight-loss prescriptions alone.1SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity The agency had originally projected the entire obesity benefit, including drug coverage and dietary counseling, would cost about $10 million a year, with $3.3 million coming from the state share.3KFF Health News. GLP-1 Drugs Weight Loss Obesity Trump Medicaid Coverage South Carolina
Federal policy shifted at the same time. In April 2025, the Trump administration announced it would not finalize a proposed rule that would have required state Medicaid programs to cover anti-obesity medications.4Georgetown University. Policy Options to Cover Anti-Obesity Drugs Without a federal mandate, weight-loss drug coverage is optional for states, and a provision in the Medicaid Drug Rebate Program statute specifically exempts anti-obesity medications from the usual rule that states cover nearly all FDA-approved drugs.5JAMA Network. Antiobesity Medications and Medicaid Coverage
Jeff Leieritz, a spokesperson for the South Carolina Department of Health and Human Services, said the agency would consider restoring coverage if drug costs decrease. He noted that Wegovy’s list price had already fallen from $1,350 to $349 per month as of late 2025.1SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity
What SC Medicaid Still Covers for Obesity and GLP-1 Use
The change applies only to obesity treatment. If your prescription is written to manage Type 2 diabetes, GLP-1 medications like Ozempic remain covered under SC Medicaid.1SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity Federal law requires states to cover drugs for FDA-approved indications like diabetes and cardiovascular disease, even though weight-loss coverage is optional.6KFF. Medicaid Coverage of and Spending on GLP-1s
For members seeking obesity treatment without drug coverage, bariatric surgery is still on the table. The South Carolina Department of Health and Human Services covers sleeve gastrectomy and other bariatric procedures for members who meet medical necessity criteria under the state’s InterQual guidelines, with prior authorization required.7SCDHHS. Coverage Bariatric Surgery Members enrolled in managed care plans should contact their plan directly for authorization details. Select Health of SC directs affected members to talk with their doctor about next steps and to verify any specific medication using the state’s searchable drug list or by calling Member Services at 1-888-276-2020.2Select Health of SC. Prescription Benefits
Health Impact
South Carolina’s adult obesity rate stands at 36 percent, with higher rates among African American adults (45.6 percent) and Native American adults (42.3 percent).8SC Department of Public Health. DPH Focused Reducing Obesity Help SC Residents Live Healthier Lives Roughly 1.5 million adults in the state are classified as obese, though state officials estimated that only about 1,300 beneficiaries would ever qualify under the prior authorization rules that governed the short-lived benefit.3KFF Health News. GLP-1 Drugs Weight Loss Obesity Trump Medicaid Coverage South Carolina
Dr. Ada Stewart, a Columbia-based family physician, called the drugs a “literal lifesaver” for her patients and said that while the policy change saves the state money now, it will lead to higher overall costs as patients develop obesity-related conditions they might otherwise have avoided.1SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity
Could Coverage Come Back?
Two developments could change the answer. In December 2025, the CMS Innovation Center introduced the BALANCE model, a five-year voluntary program designed to negotiate lower GLP-1 prices for state Medicaid programs and expand obesity drug coverage.9KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid The Medicaid component began accepting state participants in May 2026, with a July 31, 2026 application deadline.10CMS. BALANCE Model No public list of participating states has been released, and it is not yet clear whether South Carolina intends to join.11George Washington University. BALANCE Model Update
Separately, Novo Nordisk announced in February 2026 that it would reduce the list price of its GLP-1 medications to $675 per month starting in 2027.12Stateline. More States Consider Dropping GLP-1 Weight Loss Drugs From Medicaid Because state officials have tied any reconsideration to lower prices, either the BALANCE model’s negotiated rates or manufacturer price cuts could be what eventually reopens the door.
How South Carolina Compares to Other States
South Carolina is part of a broader retreat. As of January 2026, only 13 state Medicaid programs cover GLP-1 drugs for obesity, down from 16 in October 2025. California, New Hampshire, and Pennsylvania dropped coverage around the same time South Carolina did. The trend is driven by tighter state budgets, uncertainty about federal Medicaid spending, and cuts enacted in the 2025 federal reconciliation law.6KFF. Medicaid Coverage of and Spending on GLP-1s