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State coverage

Hawaii

State Medicaid · 4 documents cited

Medicaid, for obesity: Covers with conditions. The conditions and the appeal deadline are in the summary below.

At a glance

Covers with conditions
Medicaid, for obesity
Hawaii sets no statewide drug list; coverage depends on which of five QUEST health plans a member is in.
Appeal deadline
90 calendar days from the date of the notice — and for a QUEST managed-care plan's own decision, only after you've finished that plan's own grievance and appeals process source
Primary source
State of Hawaii, Department of Human Services, Med-QUEST Division, MCO Formulary Search
Date read
September 2026

Denise Ramirez, Coverage Editor · 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the drug-coverage page is dated 2009 and its prior-authorization criteria page still lists Meridia and Xenical — both withdrawn or discontinued weight-loss drugs from the 2000s — as the only entries under its anti-obesity heading.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

The state does not maintain its own QUEST formulary and says so directly, sending members and providers to each plan's own list: its MCO Formulary Search page reads "Click the following health plans to see their formulary" above links to AlohaCare, HMSA, Kaiser Permanente, 'Ohana and UnitedHealthcare — five separate, plan-specific documents.

State of Hawaii, Department of Human Services, Med-QUEST Division, MCO Formulary Search · source

One plan's formulary excludes anti-obesity drugs in its front matter, in a list that also excludes fertility and cosmetic drugs: "Plan exclusions... The following drug categories are excluded from coverage under the outpatient pharmacy benefit and are not part of the UnitedHealthcare Community Plan PDL. • DESI drugs... • Anti-obesity agents... • Agents used to promote fertility... • Agents used for erectile dysfunction."

UnitedHealthcare Community Plan, Hawaii QUEST Program Preferred Drug List, effective July 2026 · source

The same document's own drug-class table contradicts that exclusion for one drug: under "Anti-Obesity Agents - Drugs for Weight Loss," it lists "ALLI - Tier 2; QL," "QSYMIA (brand for phentermine-topiramate er) - Tier 2; PA; QL," and "WEGOVY SUBCUTANEOUS - Tier 2; PA; QL" — a covered tier with a prior-authorization and quantity-limit flag, not an excluded one. Zepbound, Mounjaro and tirzepatide do not appear anywhere in the document under any name.

UnitedHealthcare Community Plan, Hawaii QUEST Program Preferred Drug List, effective July 2026 · source

The state's fee-for-service prior-authorization page has not been updated for this drug class: its "Appetite Suppressants/Anorexiants/Fat Absorption Decreasing" criteria ask only for "Patient's weight and height (or Body Mass Index)" and "Patient's program for weight loss," with the note "Additional criteria for MERIDIA and XENICAL: refer to specific drug name" — both products no longer marketed. The page's text contains no mention of Wegovy, Zepbound, Saxenda, semaglutide or tirzepatide.

State of Hawaii, Department of Human Services, Med-QUEST Division, Fee-for-Service PA Criteria · source

The state's fair-hearing deadline is 90 days, and the rule specifically addresses managed-care members like most QUEST enrollees: "The Med-QUEST Division must receive a hearing request within ninety (90) calendar days of the date of the notice for: (1) Eligibility related decisions; (2) Fee-for-service program coverage decisions; and (3) Managed care health plan coverage decisions after completion of the managed care health plan's grievance and appeals process."

Hawaii Administrative Rules, Title 17, Chapter 1703.1, Section 17-1703.1-4 (Action on request for hearing) · source

Medicaid is only one of the routes. If you have a commercial or employer plan, the rules are different and are on the employer plans page; Medicare has a federal rule of its own, on the Part D page.

If the appeal fails, or you cannot wait

Cash-pay telehealth is the fallback, not the bargain: you pay the whole cost yourself, and a covered prescription is almost always cheaper than any of these. Use this route when coverage has actually been exhausted, or when you need to start while an appeal runs.

Companies that pay this site a commission, what we found on each one's own site, and a link to check availability
CompanyWhat we found on its own site
CoreAge RxCheck availabilityAdvertises $99 a month for compounded semaglutide, flat across doses. Read the terms before you sign up: the lander our link opens has shown $149 rather than $99, and a consultation fee can be charged on top and may not be refundable.
OakCheck availabilityFlat price across doses, free shipping with supplies.
Care Bare RxCheck availabilityNames its pharmacies with addresses; sells brand Ozempic as well as compounded.
Gala HealthCheck availabilityAll doses one price, but the advertised rate needs a yearly subscription.
Synergy RxCheck availabilityProviders licensed in your state; publishes no GLP-1 price before the consult.
Breeze MedsCheck availabilityServes all 50 states; publishes a starting price only.
Direct MedsCheck availabilityNo monthly membership, and one price at every dose. The lander our link opens starts at $147 and reads its own discount two ways on the same screen: the banner across the top says $150 off, the product tiles below it say up to $200 off.
FoundCheck availabilityBills the clinical visits through insurance where it is in network, with the medication charged separately. Read its Medicare Part D route closely: it advertises brand GLP-1s from $50 a month, and the footnote under that offer says the $50 does not count toward your Part D deductible or out-of-pocket maximum, and that Extra Help does not apply.
EdenCheck availabilityTwo different prices for the same drug depending on which door you come in. The lander our link opens advertises $99 a month for semaglutide, held at every dose, with no membership fee. Eden's own weight-loss page, read the same day, offers it from $99 a month plus an Eden Membership, and the footnote there says the membership is $39 the first month and $99 after, and that medication is not available without one.
ShedRxCheck availabilityPublishes no price before the questionnaire: you answer it, pick a plan and see the cost at checkout. Sells injections plus needle-free drops and lozenges, and a footnote on the same page names sixteen states where the oral forms are not available.
TrimiCheck availabilityCompounded tirzepatide at $125 a month and semaglutide at $99, each on the annual plan and each the same price at every dose. One membership covers the medication, the clinician visits and shipping.
He & She MDCheck availabilityAdvertises semaglutide from $99 a month and charges only if a prescription is written. The printed tiers are higher than the headline: $139 a month on six months, billed $834 at once, and $149 a month on three. GLP-1s ship to every state except Louisiana.
HealthRXCheck availabilityCompounded semaglutide from $133 a month on a three-month plan and as low as $99 on twelve; tirzepatide from $209, as low as $179. ⚠ The page states its member reviews are illustrative composites rather than real patients.
Pallas HealthCheck availabilityCompounded semaglutide at $139 for the first month and then $597 every twelve weeks, and tirzepatide at $179 then $897. ⚠ The page discloses that some of its content is AI-generated and that its imagery uses models rather than patients.
MEDGmCheck availabilityGLP-1 injections from $179 and tablets from $249, with brand-name options priced as a membership plus the cost of the drug — $99 for Zepbound or Wegovy, $171 for Ozempic. ⚠ It discloses AI-generated content and actor imagery beside more than twenty named patient testimonials.
Bodybuilding Health+Check availabilityCompounded tirzepatide runs $174.67 to $209 a month depending how many months are bought at once, and semaglutide is tiered the same way. ⚠ The program is listed as Bodybuilding.com; the page this link opens brands itself Bodybuilding Health+ and is operated by Dynamo Group LLC.
Strut HealthCheck availabilityA multi-category telehealth storefront — sexual health, testosterone, hair, skin, peptides, menopause — where weight loss is one tile among six. It publishes no price for a GLP-1, or for anything else, on the page this link opens.
RxSpan MDCheck availabilityMulti-category telehealth that promises transparent pricing and no hidden fees, and then publishes no price at all — not for a GLP-1 and not for any other product — on the page this link opens.

Prices in those notes were read from each company's own site in August 2026 and September 2026, and they change often. Check the current number before you buy.

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 — www.uhcprovider.com/content/dam/provider/docs/public/commplan/hi/pharmac
  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

Every state we have verified is in the coverage matrix. Appeal routes and deadlines are on the procedures page.