State coverage
Montana
Medicaid, for obesity: Covers with conditions. The conditions and the appeal deadline are in the summary below.
At a glance
- Medicaid, for obesity
- The standard drug list never names Wegovy or Zepbound; a separate pathway covers each for a non-obesity reason.
Montana is the state where reading only the standard drug list would get you the wrong answer. Two editions were checked eight months apart — the one revised January 15, 2026 and the one revised July 30, 2026 — and neither names Wegovy, Zepbound or Saxenda anywhere across their 33 pages, and neither carries a weight-loss or anti-obesity drug class at all. The diabetes GLP-1 class lists only Ozempic, Trulicity, Victoza and Mounjaro, each restricted to a type 2 diabetes diagnosis with a required trial of two preferred agents first.
That absence would read as a flat no if the drug list were the only document available. It is not the only document. A quarterly newsletter from Mountain Pacific Quality Health, the contractor that runs Montana's drug prior-authorization desk, lays out a separate pathway for members without diabetes: Wegovy for a liver condition called MASH or for reducing cardiovascular risk, and Zepbound for obstructive sleep apnea. Neither drug is covered for weight loss or obesity as such — the newsletter says so in those words, twice.
The standard drug list is silent on this because these approvals route through their own prior authorization forms rather than through ordinary drug-list placement, and the newsletter is currently the clearest public statement of what those forms will approve. The state's general pharmacy provider manual supplies the legal floor underneath both documents: drugs for weight reduction are excluded from coverage outright.
One host could not be verified at all. Montana's official rules website, rules.mt.gov, is a JavaScript application that returned the identical 894-byte page shell for every URL tried on 2026-09-03 — a real rule number and a nonsense one alike, byte for byte. So nothing on this page rests on that site, and the Administrative Rules of Montana provision that presumably states this exclusion in the state's own regulatory language was not read. That is a gap in what we could open, not a finding about what the rule says.
What we could verify for Montana
Neither the January 15, 2026 nor the July 30, 2026 edition of the Montana Healthcare Programs Preferred Drug List names Wegovy, Zepbound or Saxenda anywhere in its 33 pages, and neither carries a weight-loss or anti-obesity drug class. The "Diabetes: GLP-1/GIP and Combos" class lists only "Ozempic," "Trulicity" and "Victoza" as preferred and "Mounjaro," "Bydureon BCISE," "Rybelsus" and generic exenatide and liraglutide as non-preferred, each requiring a "Trial of 2 preferred agents for 6 months each" and a type 2 diabetes diagnosis.
Montana Department of Public Health and Human Services, Montana Healthcare Programs Preferred Drug List, effective July 2026 · source
The state's quarterly drug-utilization newsletter states the non-diabetes pathway directly: "Wegovy® is semaglutide, the same active ingredient as Ozempic®, but is not approved for and is not covered for type 2 diabetes. It has an FDA indication but is not covered for weight loss or obesity by Montana Healthcare Programs. Wegovy® injection is covered in adults for diagnoses: Noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis. Reduction of risk of major adverse cardiovascular events (MACE) in adults with established cardiovascular disease (CVD) and either obesity or overweight."
Mountain Pacific Quality Health, Montana's Medicaid drug prior-authorization contractor, Montana Healthcare Programs DUR Newsletter, effective March 2026 · source
The same newsletter states the Zepbound pathway: "Zepbound® is tirzepatide, the same active ingredient as Mounjaro®, but is not approved for and will not be covered for type 2 diabetes. It has an FDA indication for but is not covered for weight loss or obesity by Montana Healthcare Programs. Zepbound® is covered in adults for: A diagnosis made by a sleep specialist of obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) greater or equal to 15 while on current positive airway pressure treatment (either CPAP or BiPAP)... Body mass index (BMI) at time of sleep study was greater than or equal to 30 kg/m2, AND Member has been on PAP continuously for at least six months prior to request."
Mountain Pacific Quality Health, Montana Healthcare Programs DUR Newsletter, effective March 2026 · source
The state's Prescription Drug Program Manual lists drugs prescribed "For weight reduction" among what Medicaid does not cover, alongside drugs prescribed to promote fertility, for erectile dysfunction, or for cosmetic purposes or hair growth.
Montana Department of Public Health and Human Services, Prescription Drug Program Manual, Covered Products chapter, effective July 2026 · source
Montana's Medicaid fair-hearing policy sets the filing window: "The hearing request must be in writing and the Department must receive it within 90 days of the date the adverse action notice is mailed; the claimant's signature is not required." The chart accompanying this rule states that benefits continue "if FH requested before effective date OR within 10 days of adverse action notice (when timely notice not sent)."
Montana Department of Public Health and Human Services, Combined Medicaid Assistance Manual, CMA 1505-1 (Fair Hearings, Administrative Reviews, and Appeals), effective July 2016 · 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
- Montana Department of Public Health and Human Services, Montana Healthcare Programs Preferred Drug List, effective July 2026 — medicaidprovider.mt.gov/docs/pharmacy/2026/July2026PreferredDrugList.pdf
- Mountain Pacific Quality Health, Montana's Medicaid drug prior-authorization contractor, Montana Healthcare Programs DUR Newsletter, effective March 2026 — mountainpacificfiles.blob.core.windows.net/content/2026/03/DUR-Newslette
- Montana Department of Public Health and Human Services, Prescription Drug Program Manual, Covered Products chapter, effective July 2026 — medicaidprovider.mt.gov/manuals/prescriptiondrugprogrammanual
- Montana Department of Public Health and Human Services, Combined Medicaid Assistance Manual, CMA 1505-1 (Fair Hearings, Administrative Reviews, and Appeals), effective July 2016 — dphhs.mt.gov/assets/hcsd/mamanual/CMA1505-1July012016.pdf
Every state we have verified is in the coverage matrix. Appeal routes and deadlines are on the procedures page.