State coverage
Nevada
Medicaid, for obesity: Covers with conditions. The conditions and the appeal deadline are in the summary below.
At a glance
- Medicaid, for obesity
- Weight-management drugs are excluded by the state manual. Wegovy for heart risk, Zepbound for sleep apnea.
- Appeal deadline
- 90 calendar days from the date on the notice of decision — but if you are in a managed care plan, you appeal to the plan first source
- Primary source
- Nevada Medicaid, Web Announcement 3916
- Date read
- September 2026
Nevada writes the exclusion in one sentence and then opens two doors through it. The state's Medicaid Services Manual lists agents used for weight management among the pharmaceuticals Nevada Medicaid will not reimburse, full stop. The drugs a reader is here about are then handled as exceptions to a diabetes class, not as obesity drugs at all.
Since January 1, 2026 there is only one list. Nevada moved every health plan onto a single statewide Preferred Drug List, so the answer no longer changes when you change plans — the same drug list, the same criteria, the same prior authorization forms whether you are in fee-for-service or in a managed care plan.
The two doors are narrow and specialist-gated. Wegovy is approved for reducing cardiovascular risk in an adult who already has established heart disease, and the prescriber has to be a cardiologist or vascular specialist or be working with one. Zepbound is approved for moderate-to-severe obstructive sleep apnea, and the state wants a sleep study from an accredited facility plus compliance with the airway treatment the reader is presumably already on. A third door, for the liver condition MASH, sits in a separate section of the same manual and also runs through Wegovy.
One condition catches people out on both doors: the criteria are written for recipients who do not have diabetes. The manual says so twice, in nearly identical language, and directs recipients who do have type 1 or type 2 diabetes to alternative therapy instead. The plain diabetes pathway is a different set of criteria with different drugs on it.
Appeals in Nevada depend on who sent the letter. A managed care member goes through the plan's own appeal first and only then to the state hearings office; someone in fee-for-service goes straight to the state.
What we could verify for Nevada
One drug list now binds every Nevada Medicaid plan. The state's own announcement states that "As of January 1, 2026, Nevada Medicaid has transitioned to a Single Preferred Drug List (sPDL)" and that "The sPDL is used statewide, which means every Medicaid plan follows the same list." It also describes a "Legacy Coverage Phase" running "from January 1, 2026, through June 30, 2026" during which members could keep filling a medication that had become non-preferred.
Nevada Medicaid, Web Announcement 3916, effective January 2026 · source
The statewide drug list has no anti-obesity class. Its "Incretin Mimetics and Combinations" class lists Byetta, Ozempic, Rybelsus, Trulicity and Victoza as preferred and Bydureon BCise, exenatide, liraglutide, Mounjaro, Soliqua and Xultophy as non-preferred, and routes every one of them to "MSM 1200 - Appendix A section: KK. Incretin Mimetics." Wegovy, Zepbound and Saxenda are named nowhere in the document, under this or any other heading — a full text extraction of the 183,255-character file returns no occurrence of any of the three, nor of the words obesity or weight.
Nevada Medicaid and Nevada Check Up Preferred Drug List, effective November 2025 · source
The exclusion is in the manual, not in a formulary footnote. Under the heading "Excluded," the state writes: "Nevada Medicaid will not reimburse for the following pharmaceuticals:" and the first item on the list is "Agents used for weight management." The same section also excludes fertility agents, cosmetic and hair-growth agents, and drugs for erectile dysfunction.
Nevada Medicaid, Medicaid Services Manual Chapter 1200 — Prescribed Drugs, Section 1203, effective August 2026 · source
The diabetes criteria say the quiet part outright. Approval under the Incretin Mimetics criteria requires that the drug be prescribed either as an "Adjunct to diet and exercise to improve glycemic control in recipients with type 2 diabetes mellitus (T2DM)" or to "Reduce the risk of major adverse cardiovascular events ... in recipients with type 2 diabetes and established cardiovascular disease," plus "Documentation of A1C lab results within past 180 days" and, in its own numbered clause, that the "Medication is not being prescribed for weight loss in absence of T2DM indication." Approval runs one year.
Nevada Medicaid, Medicaid Services Manual Chapter 1200, Appendix A section KK (Incretin Mimetics), effective August 2026 · source
Wegovy has a heart-risk door, and it is specialist-gated. The exception criteria require that the "Medication is being prescribed for risk reduction of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight," that the recipient be 18 or older with a "body mass index (BMI) ≥27 kg/m2," and that "Wegovy® must be prescribed by, or in consultation with, a cardiologist or vascular specialist." Established disease means a prior heart attack, a prior stroke, symptomatic peripheral arterial disease, or a specialist's documentation. The recipient "must not have type 1 or type 2 diabetes" and "must not be utilizing another glucagon-like peptide (GLP-1) therapy." Initial approval is six months, and renewal turns on reaching the 2.4 mg weekly injection dose (or 25 mg daily for the tablet) or the prescriber explaining why that dose is not appropriate.
Nevada Medicaid, Medicaid Services Manual Chapter 1200, Appendix A section KK, exception criteria for Wegovy, effective August 2026 · source
Zepbound's only door is sleep apnea, and the state wants a sleep study. Approval requires an adult 18 or older and that the "Medication is being prescribed for moderate to severe obstructive sleep apnea (OSA) in adults with obesity," defined as "15 or more obstructive respiratory events per hour of sleep confirmed by a sleep study from a certified or accredited sleep disorder facility" — or five or more events plus a listed symptom, or, where a facility study is not possible "due to immobility, safety, or critical illness," a diagnosis from a board-certified sleep specialist or pulmonologist. The recipient must be "fully compliant with ongoing treatment(s) for the underlying airway obstruction (e.g., CPAP, BiPAP), unless there is rationale from provider as to why treatment is not indicated," must have a "body mass index (BMI) >30 kg/m2," and "must not have type 1 or type 2 diabetes." Initial and renewal approvals are six months each.
Nevada Medicaid, Medicaid Services Manual Chapter 1200, Appendix A section KK, exception criteria for Zepbound, effective August 2026 · source
A third door runs through the liver. Nevada's MASH criteria cover Wegovy for a recipient 18 or older with "a diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis stage 2 or 3" confirmed by liver biopsy, vibration-controlled transient elastography, or magnetic resonance elastography, who is "not utilizing another glucagon-like peptide (GLP-1) therapy." Renewal requires the FDA maintenance dose of 2.4 mg weekly, or 1.7 mg where the dose was reduced for intolerance. The same section makes Rezdiffra the second choice: it is approved only where the recipient "has inadequate response, intolerance, or contraindication to Wegovy® (semaglutide) for MASH treatment" or a specialist justifies expecting Wegovy to fail.
Nevada Medicaid, Medicaid Services Manual Chapter 1200, Appendix A section G (Metabolic Dysfunction-Associated Steatohepatitis), effective August 2026 · source
Nevada gives recipients 90 calendar days and counts from the date on the letter. Its hearings chapter states that "The request must be received by the Nevada Medicaid Hearings Office within 90 calendar days from the date on the Notice of Decision (NOD) issued by Nevada Medicaid or Managed Care Entity (MCE), unless a recipient can substantiate 'good cause' for not doing so. When the deadline falls on a weekend or holiday, the deadline is extended to the next working day." A 2025 law change (Assembly Bill 36) added extenuating circumstances that can excuse a late filing. Note that the date of the request is "the date the request is received," not the date it is sent.
Nevada Medicaid, Medicaid Services Manual Chapter 3100 — Hearings, Section 3104 (Recipient Hearings), effective August 2026 · source
If you are in a managed care plan, the plan's clock comes first and it is shorter. Health Plan of Nevada's Medicaid appeals page tells members "You have the right to file an appeal within 60 days of receiving a notice," and that only afterward — "after all of HPN Medicaid's appeals have been completed" — can a member ask the Nevada Medicaid Hearings Unit for a State Fair Hearing, adding "You must ask for this hearing within 90 days of receiving the final Appeal Notice from HPN Medicaid." Both of the plan's clocks run from receipt of a notice rather than from the date printed on it.
Health Plan of Nevada Medicaid (a Nevada Medicaid managed care plan; this is the plan's own page, not a state rule) · 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
- Nevada Medicaid, Web Announcement 3916, effective January 2026 — www.medicaid.nv.gov/Downloads/provider/web_announcement_3916_20260512.pd
- Nevada Medicaid and Nevada Check Up Preferred Drug List, effective November 2025 — nv.primetherapeutics.com/cms/nvm/static-assets/documents2/pdl/NV_PDL_01.
- Nevada Medicaid, Medicaid Services Manual Chapter 1200 — Prescribed Drugs, Section 1203, effective August 2026 — www.nevadamedicaid.nv.gov/siteassets/content/resources/adminsupport/manu
- Nevada Medicaid, Medicaid Services Manual Chapter 3100 — Hearings, Section 3104 (Recipient Hearings), effective August 2026 — www.nevadamedicaid.nv.gov/siteassets/content/resources/adminsupport/manu
- Health Plan of Nevada Medicaid (a Nevada Medicaid managed care plan; this is the plan's own page, not a state rule) — myhpnmedicaid.com/member/grievances-and-appeals
Every state we have verified is in the coverage matrix. Appeal routes and deadlines are on the procedures page.