State coverage
Maine
Medicaid, for obesity: Covers with conditions. The conditions and the appeal deadline are in the summary below.
At a glance
- Medicaid, for obesity
- Wegovy is covered for heart risk and a liver condition, Zepbound for sleep apnea. Weight loss stays excluded.
MaineCare's drug list carries a section headed WEIGHT LOSS, and it does not equivocate: weight-loss drugs are not covered, as permitted by federal Medicaid regulations and MaineCare policy. The list's own phrasing is "No longer covered" — Maine once paid for some of these and stopped.
Wegovy and Zepbound are not in that section. They sit instead under Cardiometabolic Health Agents and Obstructive Sleep Apnea, each covered for a reason that is not weight loss. Wegovy's route runs through reducing the risk of a major cardiac event — stroke, heart attack, symptomatic peripheral artery disease — in a patient who also has obesity or overweight, or through a liver condition called MASH. The drug list closes the loop with its own qualifier on the Wegovy entry: the patient's BMI must be over 27, and the drug must not be used for weight loss only.
Zepbound's route is narrower still and runs through sleep medicine rather than cardiology: a diagnosed case of moderate-to-severe obstructive sleep apnea, confirmed by a sleep study within the last three years, plus a documented history that CPAP either failed or could not be tolerated for at least 90 days.
The regulation behind all of this is old. MaineCare's benefits manual excludes anorexic and certain weight-loss drugs as a non-covered service — a provision the state's own hosted copy still stamps with a 2012 revision date, years before any of the current GLP-1s existed. Nothing in the current drug list contradicts it; the newer cardiometabolic and sleep-apnea pathways were built as exceptions that route around it, not as changes to it.
What we could verify for Maine
The current drug list carries a section headed WEIGHT LOSS and states: "No longer covered: Phentermine, Xenical, Didrex, and Weight loss drugs are not covered as permitted by Federal Medicaid regulations and Maine Medicaid (MaineCare) Policy."
MaineCare (Maine Department of Health and Human Services), MaineCare Preferred Drug List, effective July 2026 · source
The same drug list covers Wegovy for two reasons that are not weight loss. Under Cardiometabolic Health Agents, the criteria read: "Indication for use is Major Adverse Cardiac Event (MACE) Reduction: Patient has history of at least one of the following: Stroke, Myocardial Infarction, Symptomatic peripheral arterial disease," and separately, "Indication for use is Metabolic Dysfunction-Associated Steatohepatitis (MASH): Patient has metabolic dysfunction-associated steatohepatitis with moderate to advanced liver fibrosis... Medication is being prescribed or in consultation with gastroenterologist, hepatologist, or endocrinologist." A closing note on the Wegovy entry reads: "Wegovy: Patient has BMI > 27 kg/m2, and is not being used for weight loss only."
MaineCare (Maine Department of Health and Human Services), MaineCare Preferred Drug List, effective July 2026 · source
The same list covers Zepbound only through sleep medicine: "Zepbound for adults with a BMI ≥ 30 mg/kg2 and diagnosis of moderate to severe OSA, confirmed by sleep study within the last 3 years documenting AHI ≥ 15, AND in which CPAP is ineffective (AHI > 5 during therapeutic section of sleep study) or patient is unable to tolerate CPAP for at least 90 days AND for whom lifestyle modifications have been attempted for at least 3 months with failure to achieve weight loss. Note: Not for patients with T1DM, T2DM."
MaineCare (Maine Department of Health and Human Services), MaineCare Preferred Drug List, effective July 2026 · source
The MaineCare Benefits Manual states the underlying exclusion by regulation: under Non-Covered Services, "MaineCare does not reimburse for the following drugs or products as drugs: A. Anorexic or certain weight loss drugs." The document is stamped "LAST UPDATED 7/1/12" on every page and is still the version hosted at maine.gov.
MaineCare Benefits Manual, 10-144 C.M.R. Chapter 101, Chapter II, Section 80 (Pharmacy Services), effective July 2012 · source
MaineCare's own administrative rule sets the filing window: "Unless otherwise specified in this Chapter, a request for an administrative hearing must be received within sixty (60) calendar days of the date of written notification to the member of the action the member wishes to appeal." A separate, shorter clock governs keeping your drug while you appeal: MaineCare services "currently being provided will not be terminated, reduced, or suspended until an administrative hearing decision is rendered provided that the member requests an administrative hearing before the date of action."
MaineCare Benefits Manual, 10-144 C.M.R. Chapter 101, Chapter I, Section 1, §1.24 · 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.
These companies pay us a commission if you start care through the links below. That is how this site is funded, and it does not change what is written above. How we pay for this.
| Company | What we found on its own site |
|---|---|
| CoreAge RxCheck availability | Advertises $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 availability | Flat price across doses, free shipping with supplies. |
| Care Bare RxCheck availability | Names its pharmacies with addresses; sells brand Ozempic as well as compounded. |
| Gala HealthCheck availability | All doses one price, but the advertised rate needs a yearly subscription. |
| Synergy RxCheck availability | Providers licensed in your state; publishes no GLP-1 price before the consult. |
| Breeze MedsCheck availability | Serves all 50 states; publishes a starting price only. |
| Direct MedsCheck availability | No 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 availability | Bills 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 availability | Two 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 availability | Publishes 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 availability | Compounded 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 availability | Advertises 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 availability | Compounded 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 availability | Compounded 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 availability | GLP-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 availability | Compounded 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 availability | A 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 availability | Multi-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
- MaineCare (Maine Department of Health and Human Services), MaineCare Preferred Drug List, effective July 2026 — www.mainecarepdl.org/content/dam/ffs-medicare/me/pdl/pdl-070126.pdf
- MaineCare Benefits Manual, 10-144 C.M.R. Chapter 101, Chapter II, Section 80 (Pharmacy Services), effective July 2012 — www.maine.gov/dhhs/sites/maine.gov.dhhs/files/documents/S80P_Pharmacy.pd
- MaineCare Benefits Manual, 10-144 C.M.R. Chapter 101, Chapter I, Section 1, §1.24 — www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c1s001.docx
Every state we have verified is in the coverage matrix. Appeal routes and deadlines are on the procedures page.