MI Medicaid Anti-Obesity/Weight Loss GLP-1 Agent Benefit Reduction
Effective 01/01/2026, Michigan (MI) Medicaid pharmacy drug coverage of GLP-1 agonist agents Wegovy, Zepbound, Saxenda, and liraglutide generic for Saxenda, when used exclusively for the treatment of Obesity, is changing in accordance with requirements of the State of Michigan 2026 Budget Legislation. This is applicable to all Michigan Medicaid beneficiaries including fee-for-service Medicaid, and managed care plan members (e.g. this change is not exclusive to MI Meridian Medicaid.)
Coverage of these GLP-1 agonists when prescribed solely to treat obesity will be reduced. Starting 01/01/2026, in order to be approved for coverage the patient must be classified as morbidly obese, have documented failure of all other clinically appropriate weight-loss interventions, trial and failure of Preferred Drug List [PDL] preferred anti-obesity agents, and the agent must be used only as a measure to avert the need for bariatric surgery.
- Prior authorizations [PA] for patients that were approved for these GLP-1 agents before 01/01/2026 will be honored for their existing 6-month approval durations. However, at the time of the next renewal request, new clinical PA requirements will apply for all requests for Wegovy, Zepbound, Saxenda if prescribed solely to treat obesity, with stricter PA requirements as outlined above.
Clinical PA criteria for GLP-1 medications requested only for weight loss starting January 1, 2026, will be updated to reflect the new legislative requirements and will be posted by MDHHS as soon as possible on MDHHS' pharmacy website: https://mi.primetherapeutics.com/ >> Provider Portal >> Documents >> Other Drug Information >> Clinical and PDL PA Criteria (PDL Class Anti-Obesity Agents).
Meridian and MDHHS have both issued direct communication to patients that have recently filled one of these drugs with mailed letter notifications describing this coverage change and the information above starting in early December 2025.
For more information, Please refer to the complete published L-Letter L 25-73 from MDHHS with Subject "Update of Pharmacy Drug Coverage for Treatment of Obesity". This has been distributed to all Medicaid providers.