Mississippi Medicaid and GLP-1 coverage

The state says plainly that it covers some of these drugs and that approval is required first. The criteria document's words are: "While there are various medications with differing mechanisms of action that are FDA-approved to treat obesity, Mississippi Medicaid covers select agents for this condition. Coverage, subject to prior authorization, is outlined below." It lists as preferred "Saxenda or Wegovy for ages 12 years and older" and "Foundayo and Zepbound for ages 18 years and older," with "Xenical or orlistat" non-preferred.

Mississippi Division of Medicaid, effective July 2026 · source

The same document names four drugs it will not pay for, and gives its reason for each. Contrave and Qsymia are listed as "not rebated through CMS." Phentermine and Evekeo/amphetamine are listed on a clinical ground rather than a rebate one. The document also states that coverage "will be limited to only one covered product at a given time" and that "Mississippi Medicaid will not cover concurrent use of two or more agents for the treatment of obesity."

Mississippi Division of Medicaid, effective July 2026 · source

The adult entry criteria are a BMI floor with a comorbidity alternative. The form asks for "BMI 30 or greater" or "BMI 27 to 29 with at least one weight-related comorbidity," and names the comorbidities it will accept — hypertension, hyperlipidemia, glucose dysregulation, obstructive sleep apnea, cardiovascular disease and MASLD among them — each with the evidence it wants, mostly a claims history of the relevant medication. For ages 12 to 17 the routes are Saxenda at a body weight above 60 kg with a BMI corresponding to 30 or greater for adults, or Wegovy at a BMI above the 95th percentile for age and sex. The initial authorization runs 12 months.

Mississippi Division of Medicaid, effective July 2026 · source

Continuing is its own test, and one half of it is about pharmacy records rather than about you. To reauthorize, the form asks "Has the patient been adherent, as evidenced in paid pharmacy claims? Adherence is defined as at least 9 claims in the past year," with room to explain a shortfall. It also asks whether the patient is tolerating the maintenance or target dose from the package insert, and whether the treatment goal from the last approval was reached. The document separately states that Mississippi Medicaid "does not cover medications for treatment of obesity during pregnancy or for mothers who are breast-feeding."

Mississippi Division of Medicaid, effective July 2026 · source

If Medicare is your primary coverage, Mississippi wants that route finished first. The criteria document states: "Medicaid is the payer of last resort. In accordance with Medicaid's cost avoidance requirements, for members who have Medicare Part D as their primary coverage, all efforts through Medicare Part D should be exhausted up to and including an Appeal. Please submit a copy of the Appeal denial letter along with supporting clinical documentation and required PA forms for review for coverage by MS Medicaid." It adds that "Medicaid does not cover Medicare Part D copay."

Mississippi Division of Medicaid, effective July 2026 · source

The state regulation excludes weight-loss drugs and carves obesity back out in the same breath. Title 23 Part 214, Rule 1.3, lists among excluded or restricted drugs: "Drugs when used for anorexia, weight loss, or weight gain, except selected drugs used to treat obesity." The same part sets a turnaround for prior authorization decisions of twenty-four hours from receipt of the request, and requires a seventy-two hour emergency supply to be dispensed where a decision is not available.

Mississippi Administrative Code Title 23, Part 214 (Pharmacy Services), Mississippi Division of Medicaid, effective December 2023 · source

One drug list covers everybody, and the state says so rather than leaving it to be inferred. The preferred drug list page states: "The Mississippi Division of Medicaid (DOM)'s universal preferred drug list (PDL) is for all Medicaid, MississippiCAN (MSCAN) and Children's Health Insurance Program (CHIP) beneficiaries." The prior authorization form carries the same scope in its header line, addressed to Medicaid fee-for-service, MSCAN and MSCHIP members together.

Mississippi Division of Medicaid, effective September 2026 · source

Two of the four preferred drugs are recent arrivals, and the committee record dates the change. The Pharmacy and Therapeutics Committee minutes for May 12, 2026 record that the state's pharmacy vendor "recommended designating Foundayo and Zepbound as preferred," that the motion carried, and that "The implementation for Preferred Drug List (PDL) changes discussed today would take effect July 1, 2026." The lists bear this out: the June 1, 2026 list carries neither drug in the anti-obesity class, and the September 1, 2026 list carries both.

Mississippi Division of Medicaid, Pharmacy & Therapeutics Committee, effective July 2026 · source

The state's hearing window is thirty days and it runs from a postmark. Title 23 Part 300, Rule 2.8, states: "The applicant or beneficiary has thirty (30) days from the postmark date of the appropriate notice to request either a local or state hearing. This thirty (30) day filing period may be extended if the applicant or beneficiary can show good cause, as determined by the Division of Medicaid, for not filing within thirty (30) days." Keeping a benefit running is a separate and shorter clock: Rule 2.21 requires the continuation request to reach the regional office "within ten (10) days from the notice date of the adverse action," and warns the division may recover the cost of services furnished solely under that provision. For managed care members, Rule 1.2 states that beneficiaries and providers "must exhaust all appeals with the coordinated care organizations (CCOs) prior to requesting a fair and/or administrative hearing with the Division of Medicaid."

Mississippi Administrative Code Title 23, Part 300 (Appeals), Mississippi Division of Medicaid, effective March 2023 · source