Minnesota

Minnesota names the anti-obesity drugs it covers and requires approval for all of them. Its criteria page, headed "Drug - Anti-Obesity Medications" and dated August 2026, lists as "Covered drugs with prior authorization": benzphetamine, Contrave, diethylpropion, Lomaira, orlistat, phendimetrazine, phentermine capsules and tablets, Saxenda, Wegovy, Xenical and Zepbound.

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

The entry test is a body mass index floor with a comorbidity alternative, and it is age-banded. The criteria require a baseline BMI "Greater than or equal to 30 kg/m2 with no risk factors (for patient at least 18 years of age)" or "Greater than or equal to 27 kg/m2 with at least one weight-related comorbid condition (e.g. hypertension, type 2 diabetes mellitus, or dyslipidemia) (for patient at least 18 years of age)" or "Greater than or equal to 30 kg/m2 and body weight above 60 kg (for patient 12 to 17 years of age)." The state also asks that "Patient's weight at baseline (in kg) must be submitted at time of request," and requires documented diet or dietitian care plus increased physical activity unless a comorbidity makes it inadvisable. There must be "No concurrent use of any other weight loss drug(s)."

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

How long a first approval lasts depends on which drug it is, and one group cannot be renewed at all. The criteria give "6 months for Saxenda, Wegovy, Contrave, Xenical or orlistat; and may be renewed if renewal criteria is met," against "3 months for phentermine tablets and capsules, Lomaira, benzphetamine, diethylpropion or diethylpropion ER, phendimetrazine or phendimetrazine ER; and cannot be renewed." For both groups the page adds that after a lapse in therapy, "additional trials may be approved if initial approval criteria is met."

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

Continuing turns on a measured result, and the measure changes with age. To renew, a patient "at least 18 years of age, must have at least 5% weight loss during the initial approval period," or a patient "12 to 17 years of age, must have at least 5% reduction in baseline BMI during the initial approval period," alongside ongoing diet or dietitian care and ongoing physical activity. A renewal runs 12 months. There is a second, different test further out: "Subsequent renewal approval (beyond 18 months) requires meeting all renewal criteria and documentation that patient maintains weight loss achieved during the initial approval period."

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

Which criteria page applies is decided by the reason for the prescription, not by the drug. Minnesota's Weight Management Agents page states that "All drugs require prior authorization," and then splits: for drugs "being requested for weight loss purposes, coverage may be provided if members meet the prior authorization (PA) criteria for 'Anti-Obesity Medications'," while "For agents with other FDA-approved indications that are not being requested for weight loss purposes," the criteria on that page govern instead.

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

Each non-weight-loss route asks for a named specialist to be involved. The cardiovascular pathway requires a "Diagnosis of established cardiovascular (CV) disease," documented management of CV risk factors, and that the "Requested agent is prescribed by or in consultation with a cardiologist." The liver pathway requires noncirrhotic MASH with "Moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis)" and consultation with "a gastroenterologist or hepatologist." All routes require no concurrent use of another GLP-1 receptor agonist, and initial and renewal approval run up to 12 months.

Minnesota Department of Human Services, Minnesota Health Care Programs, effective August 2026 · source

Minnesota's appeal window is 30 days and it runs from receipt, with a longer route for good cause. The statute provides that an individual "may contest the specified action, decision, or final disposition before the state agency by submitting a written request for a hearing to the state agency within 30 days after receiving written notice of the action, decision, or final disposition, or within 90 days of such written notice if the applicant, recipient, patient, or relative shows good cause, as defined in section 256.0451, subdivision 13, why the request was not submitted within the 30-day time limit." The same section opens by deferring to any different time frame set by federal or Minnesota law.

Minnesota Statutes §256.045, subdivision 3, Office of the Revisor of Statutes · source