State coverage

Hawaii Medicaid and GLP-1 coverage

State Medicaid · 4 documents cited

Medicaid, for obesity: Depends on your plan. The conditions and the appeal deadline are in the summary below.

AGAmerican GLP, Publisher · Who writes this site

Hawaii is a harder state to answer than most on this site because it does not run a single Medicaid pharmacy benefit. Nearly all Hawaii Medicaid members are enrolled in QUEST Integration, the state's managed-care program, and the state's own Pharmacy page sends providers to five separate health-plan formularies — AlohaCare, HMSA, Kaiser Permanente, 'Ohana and UnitedHealthcare — rather than publishing one list of its own. We opened one of those five, UnitedHealthcare Community Plan's, in full; the other four were not opened, so nothing below describes them.

That one plan is worth reading closely because it contradicts itself. Its front-matter "Plan exclusions" section lists "Anti-obesity agents" as a category excluded from the pharmacy benefit entirely. Its own drug-class tables, further into the same 250-page document, list Wegovy under "Anti-Obesity Agents – Drugs for Weight Loss" as a covered, prior-authorized drug. Zepbound and Mounjaro do not appear anywhere in the document at all — not even as excluded line items — while Ozempic and Rybelsus are covered for diabetes. We are reading the operative drug-class table as the plan's real answer, since a boilerplate exclusion list is the more likely place for stale text to survive a formulary update, but a member should not have to resolve that contradiction themselves.

The state's own fee-for-service pages, which cover the much smaller population still on traditional Medicaid rather than a QUEST plan, are of little help here: the drug-coverage page is dated 2009 and its prior-authorization criteria page still lists Meridia and Xenical — both withdrawn or discontinued weight-loss drugs from the 2000s — as the only entries under its anti-obesity heading. Neither page names Wegovy, Zepbound, Saxenda, semaglutide or tirzepatide anywhere in its text, which reads less like a considered exclusion and more like a page nobody has updated for this drug class.

What we could verify for Hawaii

Hawaii is the only state in the matrix whose Medicaid answer is “Depends on your plan”. Hawaii Medicaid's rule doesn't reach a job-based plan or Medicare. If you have one of those, read employer plans or Medicare Part D instead, and compare Hawaii with the rest in the coverage matrix.

Regional insurers that sell plans in Hawaii and have their own page here, quoted from their own policy documents: Kaiser Permanente Hawaii. The national insurers are on the insurance index.

Where this comes from

1. State of Hawaii, Department of Human Services, Med-QUEST Division, MCO Formulary Search — medquest.hawaii.gov/en/plans-providers/pharmacy/drug-coverage/mco-formul
2. UnitedHealthcare Community Plan, Hawaii QUEST Program Preferred Drug List, effective July 2026 — Open the document
3. State of Hawaii, Department of Human Services, Med-QUEST Division, Fee-for-Service PA Criteria — medquest.hawaii.gov/en/plans-providers/pharmacy/drug-coverage/pa-criteri
4. Hawaii Administrative Rules, Title 17, Chapter 1703.1, Section 17-1703.1-4 (Action on request for hearing) — humanservices.hawaii.gov/wp-content/uploads/2013/10/HAR-17-1703.1-APPEAL