Louisiana Medicaid and GLP-1 coverage

One list and one form govern every Louisiana Medicaid member. The drug list's first page states: "The PDL applies to all individuals enrolled in Louisiana Medicaid, including those covered by one of the managed care organizations (MCOs) and those in the Fee-for-Service (FFS) program." It adds that "All MCOs and FFS use the same PA Request Form." The edition read here shows "Effective Date: July 1, 2026" on its face.

Louisiana Department of Health, Louisiana Medicaid Preferred Drug List, effective July 2026 · source

The drug list flags the patient's own paperwork in the drug entry. Both "Wegovy® (Semaglutide) Injection/Tablet" and "Zepbound™ (Tirzepatide)" carry the annotation "PATIENT TREATMENT AGREEMENT" alongside their clinical-authorization and quantity-limit codes.

Louisiana Department of Health, Louisiana Medicaid Preferred Drug List, effective July 2026 · source

The agreement is signed by the patient, one initial per statement. The tirzepatide form instructs the prescriber to "submit the completed treatment agreement with the initial clinical authorization request", and tells the patient: "Please read this treatment agreement carefully. Please initial each item to show you have read and understand it." The six statements include "I will take Zepbound® like my doctor said. I will not miss doses or share my medicine with anyone", "I will follow a reduced calorie diet as directed by my doctor" and "I will increase my physical activity as directed by my doctor" — each printed with a period the quotation marks here leave out — above a patient signature and date.

Louisiana Medicaid, Tirzepatide (Zepbound®) Treatment Agreement for Louisiana Medicaid Recipients, effective January 2026 · source

Wegovy has two indications here and neither is obesity on its own. The criteria are headed "Approval Criteria for Specific Diagnoses: Established Cardiovascular (CV) Disease (Wegovy Injection or Tablet)" and, separately, MASH for the injection only. The cardiovascular route requires that "The recipient is 45 years of age or older", a documented BMI of at least 27, and — where the history is a prior myocardial infarction — that the recipient's "current risk stratification of yearly risk for CV death or MI" is stated, that they are on high-intensity statin therapy or have a medical reason not to be, that blood pressure is under 130/80 or they are on two or more of an ACE inhibitor, ARB or beta-blocker, and that they are taking aspirin or have a medical reason not to.

Louisiana Medicaid, Semaglutide (Wegovy®) clinical authorization criteria, effective March 2026 · source

Renewal is graded rather than pass-fail, and falling short buys a shorter approval. The Wegovy criteria set a "Duration of approval for continuation / maintenance of therapy: 3-6 months", then specify, in two bullets: "For weight loss > 5%, approve for an additional 6 months" and "For weight loss < 5%, approve for 3 months if clinical justification is provided as to why this weight loss goal was not reached".

Louisiana Medicaid, Semaglutide (Wegovy®) clinical authorization criteria, effective March 2026 · source

Zepbound's only door is sleep apnea, and one criterion is a diagnosis you must not have. Initiation requires that "The recipient is 18 years of age or older", that "The patient has an established diagnosis of moderate to severe obstructive sleep apnea (OSA) with a sleep study apnea-hypopnea index (AHI) of ≥ 15", and that "The prescriber states on the request that the recipient does not have central or mixed sleep apnea" — the source continues "; AND" rather than ending there. It must also be prescribed alongside positive airway pressure therapy unless the recipient has a history of non-adherence to it or clinical justification is given for going without.

Louisiana Medicaid, Tirzepatide (Zepbound®) clinical authorization criteria, effective January 2026 · source

Louisiana publishes no appeal deadline and says plainly that it is on your letter. Asked "What are the deadlines?", the state answers: "The notice of denial will tell you when to file your appeal. You must file an appeal by that date." It does publish the clock that keeps a drug coming: "If you appeal within 10 days of the denial, your current services won't be stopped while your appeal is reviewed."

Louisiana Department of Health, How to appeal a Medicaid decision · source

A warning for anyone checking this themselves: Louisiana publishes two near-identical drug list addresses and one of them is six years out of date. The address ending /HealthyLa/Pharmacy/PDL.pdf serves the list whose face reads "Effective Date: July 1, 2026"; the address ending /HealthyLa/PDL/PDL.pdf serves one whose face reads "Effective Date: July 1, 2020". Both return a valid PDF. The 2020 edition names none of these drugs, so quoting it would produce a confident and wrong conclusion about Louisiana.

Louisiana Department of Health, Louisiana Medicaid Preferred Drug List (superseded 2020 edition, still served), effective July 2020 · source · current list