State coverage
New York Medicaid and GLP-1 coverage
Medicaid, for obesity: Other diagnoses only. The conditions are in the summary below, along with why no appeal deadline could be published for this state.
At a glance
- Medicaid, for obesity
- Weight loss has never been a covered reason. Two GLP-1s are covered for other uses, both behind a high BMI.
- Appeal deadline
- Not published here — health.ny.gov returned 403 and otda.ny.gov refused the connection on every content path tried, so the state's own rule could not be opened. A block is not an absence. Federal ceiling: no more than 90 days.
- Primary source
- New York State Department of Health, NYRx
- Date read
- August 2026
New York is not a state that changed its mind. Its own pharmacy program puts it flatly: weight loss is not and never has been a Medicaid-covered indication in New York, and it points at the regulation that says so. There is no reversal here and no bulletin announcing one, which is why New York never appeared on the lists of states that dropped coverage.
What is worth knowing is the part underneath that. New York does pay for two of these drugs — but for reasons that are not weight loss, and behind conditions most people would not clear. Both come with a body mass index requirement well above the threshold in the drug labeling, both require documented lifestyle participation, and both are capped at two treatment attempts in your lifetime.
There is no New York filing deadline on this page, and that is deliberate. New York's own fair-hearing materials would not open: health.ny.gov returned 403 Forbidden on every path tried and otda.ny.gov refused the connection outright, though its robots.txt loaded, so the sites were up and it was the content that would not come. A blocked page is not a published deadline, and a number copied from somewhere else is not one either. Go by the date on your notice; the federal ceiling is on the procedures page.
What we could verify for New York
New York's Medicaid pharmacy program excludes GLP-1 drugs when they are used for weight loss, citing the state regulation at 18 NYCRR §505.3(g)(3). Its wording leaves no room: "Weight loss is not and never has been a Medicaid-covered indication. GLP-1 agonists, including but not limited to Ozempic, Wegovy, and Mounjaro are excluded from coverage for weight loss indications."
New York State Department of Health, NYRx, effective July 2026 · source
The state's pharmacy manual says the same thing from the billing side, listing "Drugs used for the treatment of anorexia, weight loss or weight gain" among the categories Medicaid will not reimburse, under the federal statute at SSA §1927(d)(2).
New York State Department of Health, eMedNY, effective March 2026 · source
Wegovy is covered, but not for weight loss. The state's criteria require a confirmed diagnosis of cardiovascular disease, a body mass index the document writes as greater than 40, and confirmation that you are taking part in lifestyle changes that support cardiovascular health. It is capped at two treatment attempts per lifetime.
New York State Department of Health, NYRx, effective July 2026 · source
Zepbound is covered on the same pattern, for obstructive sleep apnea rather than for weight. The criteria require a confirmed OSA diagnosis, a body mass index the document writes as 40 or more, and confirmed participation in lifestyle changes, again capped at two treatment attempts per lifetime.
New York State Department of Health, NYRx, effective July 2026 · source
In New York the answer above is your answer even if you are in a managed care plan. The state moved the pharmacy benefit out of the plans and into NYRx on April 1, 2023, and its letter to pharmacists says the move covers all mainstream managed care plans, including Health and Recovery Plans and HIV Special Needs Plans.
New York State Department of Health, NYRx, effective April 2023 · source
New York is one of 33 states whose Medicaid gives the same answer: weight loss excluded; heart, liver or sleep apnea can qualify. New York Medicaid's rule doesn't reach a job-based plan or Medicare. If you have one of those, read employer plans or Medicare Part D instead, and compare New York with the rest in the coverage matrix.
Regional insurers that sell plans in New York and have their own page here, quoted from their own policy documents: Highmark Blue Cross Blue Shield. The national insurers are on the insurance index.
If you work for the State of New York
State employees aren't on Medicaid, so the answer above isn't yours. Your plan is the one the state buys for its workers: Empire Plan (NYSHIP). Its pharmacy benefit runs through CVS Caremark.
Covered with prior authorization
The Empire Plan's 2026 drug list carries Wegovy, Zepbound and liraglutide under anti-obesity agents, each needing prior authorization. The criteria behind that approval aren't in the documents we could open.
Under "ANTI-OBESITY AGENTS" the list shows "liraglutide PA", "CONTRAVE PA", "WEGOVY PA" and "ZEPBOUND PA", where "PA = Prior Authorization".
NYS Department of Civil Service, 2026 Empire Plan Advanced Flexible Formulary Preferred Drug List, effective January 2026 · source
Qsymia is on the excluded list, with "liraglutide PA, CONTRAVE PA, WEGOVY PA, ZEPBOUND PA" as the preferred alternatives.
NYS Department of Civil Service, 2026 Empire Plan Advanced Flexible Formulary Preferred Drug List, effective January 2026 · source
The April 2026 edition still lists "liraglutide PA", "WEGOVY PA" and "ZEPBOUND PA" under anti-obesity agents.
NYS Department of Civil Service, 2026 Empire Plan Advanced Flexible Formulary (April 2026), effective April 2026 · source
"You must have prior authorization for certain drugs, including generic equivalents, noted with "PA" on the Empire Plan Advanced Flexible Formulary." The prescription program is "administered by CVS Caremark."
NYSHIP, At a Glance (CSEA), 2026, effective January 2026 · source
If the appeal fails, or you cannot wait
New York Medicaid excludes weight loss but can still approve these drugs for another approved use, set out in the facts above. If none of those applies to you, cash-pay telehealth is the fallback: you pay the whole cost yourself, with no Medicaid help.
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 |
|---|---|
| PartnerEdenCheck availability | Semaglutide at $99 a month at every dose, with no membership on the page our link opens. Eden's own site pairs the same $99 with a required membership ($39 the first month, then $99), so check which one you're signing up for. |
| PartnerShedRxCheck availability | Injections plus needle-free drops and lozenges. You see a price only after the questionnaire, and the oral forms aren't sold in sixteen states. |
| PartnerHealthRXCheck availability | Compounded semaglutide at $133 a month on a three-month plan ($99 on twelve), tirzepatide from $209 ($179 on twelve). Its member reviews are labeled illustrative composites, not real patients. |
| PartnerMEDGmCheck availability | GLP-1 injections from $179 and tablets from $249. Brand options are a membership plus the drug's own cost: $99 for Zepbound or Wegovy, $171 for Ozempic. It discloses AI content and actor imagery. |
| PartnerBodybuilding Health+Check availability | Compounded tirzepatide at $174.67 to $209 a month, lower the more months you buy at once; semaglutide is tiered the same way. Operated by Dynamo Group LLC. |
| PartnerStrut HealthCheck availability | A telehealth storefront where weight loss is one of six categories. No GLP-1 price is published on the page our link opens. |
All 21 companies, with what we found on each →
Prices in those notes were read from each company's own site in September 2026, and they change often. Check the current number before you buy.
Where this comes from
- New York State Department of Health, NYRx, effective July 2026 — Open the document
- New York State Department of Health, eMedNY, effective March 2026 — Open the document
- New York State Department of Health, NYRx, effective July 2026 — Open the document
- New York State Department of Health, NYRx, effective July 2026 — Open the document
- New York State Department of Health, NYRx, effective April 2023 — Open the document