State coverage
South Carolina Medicaid and GLP-1 coverage
Medicaid, for obesity: Other diagnoses only. The conditions and the appeal deadline are in the summary below.
At a glance
- Medicaid, for obesity
- Removed GLP-1s for obesity from its drug list on December 31, 2025. Wegovy survives for heart and liver.
- Appeal deadline
- 30 calendar days following receipt of the notice, by postmark. 10 days from the date on the notice to keep services running source
- Date read
- September 2026
South Carolina stopped covering GLP-1s for obesity at the end of 2025, and the way you can tell is unusual enough to be worth explaining.
There is no provider bulletin announcing it. The state's own record of the decision is a line in the minutes of its Pharmacy and Therapeutics Committee, where a state medical director told the committee the drugs would come off the drug list and gave the date. That is a real, dated, state-published document — it is just not where most people would look.
The drug list itself corroborates it. The edition in force at the start of 2026 carries a weight management class with Wegovy in it; the next edition published does not carry that class at all, and neither does the one in force now. The diabetes GLP-1s stayed exactly where they were, which is how you can tell the class was removed rather than the document reorganized.
What survives is narrow and specific, and the minutes say so: Wegovy remains covered for indications other than obesity, and someone already taking it for one of those may need a fresh prior authorization to keep it.
What we could verify for South Carolina
The state's own record of the decision is in its P&T Committee minutes, under State Updates: "Dr. Wessinger notified committee members that GLP-1 medications for obesity would be removed from the PDL 12/31/2025. There will be no changes to GLP-1 products with respect to the indication for diabetes. Wegovy will continue to be covered for indications other than obesity (e.g., MACE/MASH). If members are currently taking Wegovy for these indications, they may require a new Prior Authorization for those indications." The minutes are headed November 5, 2025.
South Carolina Department of Health and Human Services, Pharmacy and Therapeutics Committee Meeting Minutes, effective November 2025 · source
The drug list in force at the start of 2026 still carried the class. Under the headings "WEIGHT MANAGEMENT AGENTS" and "INJECTABLE GLP-1 AGENTS" it stated "Clinical Criteria applies to all drugs in this class", listed "Wegovy® Injection" as preferred, and listed "liragtutide injection (generic for Saxenda®)" and "Saxenda® Injection" as non-preferred. The edition's face reads "Effective Date: 01/01/2026". (The misspelling of liraglutide is the document's own.)
South Carolina Healthy Connections Medicaid, Single Preferred Drug List, effective 01/01/2026, effective January 2026 · source
The class is gone from the list in force now, and the diabetes drugs are untouched, which is how you can tell the class was removed rather than renamed. The edition whose face reads "Effective Date: 09/01/2026" has no weight management class and no injectable GLP-1 weight-loss class, and it names neither Wegovy nor Saxenda anywhere, while Ozempic, Mounjaro and insulin are still listed, just as they were in the January edition that did carry Wegovy and Saxenda.
South Carolina Healthy Connections Medicaid, Single Preferred Drug List, effective 09/01/2026, effective September 2026 · source
The current GLP-1 criteria are now a diabetes document. The state's "GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists Criteria", stamped "Revised 05/01/2026", runs to about 2,900 characters and contains no occurrence of "weight", "obes", "BMI", "Wegovy", "Saxenda" or "Zepbound", against control counts of three for "diabetes" and two for "Ozempic".
South Carolina Healthy Connections Medicaid, GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists Criteria, effective May 2026 · source
A separate and older exclusion sits underneath all of this, and it is absolute on its face. The Pharmacy Services Provider Manual dated JULY 1, 2026 lists, under "NON-COVERED SERVICES AND DEFINITIONS", products "excluded from Healthy Connections coverage" that "are considered non-covered, regardless of circumstance", and the first bullet is "Weight control products".
South Carolina Department of Health and Human Services, Pharmacy Services Provider Manual, effective July 2026 · source
South Carolina never announced this in a provider bulletin. Across all 364 bulletins the department has published, not one mentions weight, obesity, GLP-1s, Wegovy, Saxenda, Zepbound, Mounjaro or Ozempic — though 26 of them match "pdl", "pharmac" or "drug", so they are absent from the archive rather than from our reading of it. The P&T minutes above are the only announcement there is.
South Carolina Department of Health and Human Services, Medicaid bulletins archive · source
Two different clocks run after a denial and the shorter one is the one that keeps your drug coming. The department states that "A request for a fair hearing by mail is considered filed if postmarked by the 30 calendar day following receipt of this notification", and separately that "You may also request continued benefits or services if you request continued services within 10 days of the date on the notice." It adds that "Ordinarily, member appeals should be concluded within 90 days of filing" — a decision timeline, not a filing deadline.
South Carolina Department of Health and Human Services, File an Appeal · source
South Carolina is one of 33 states whose Medicaid gives the same answer: weight loss excluded; heart, liver or sleep apnea can qualify. South Carolina 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 South Carolina with the rest in the coverage matrix.
If you work for the State of South Carolina
State employees aren't on Medicaid, so the answer above isn't yours. Your plan is the one the state buys for its workers: State Health Plan (PEBA). Its pharmacy benefit runs through CVS Caremark.
Weight loss drugs excluded
South Carolina's State Health Plan excludes prescription drugs used for weight loss. GLP-1s for covered uses need prior approval and are limited to a 30-day supply per fill.
Among drugs that are not covered: "Prescription drugs used for weight loss".
South Carolina Public Employee Benefit Authority, 2026 Insurance Benefits Guide, effective January 2026 · source
The plan exclusions include "Weight loss treatments and all weight loss surgery, including, but not limited to: medications".
South Carolina Public Employee Benefit Authority, 2026 Insurance Benefits Guide, effective January 2026 · source
"Note, however, that specialty medications and GLP-1s are limited to a 30-day supply per fill."
South Carolina Public Employee Benefit Authority, 2026 Insurance Benefits Guide, effective January 2026 · source
PEBA board materials: "Weight loss coverage is a Plan exclusion", and the Board approved "placing a new prior approval process for GLP-1s to now require documentation that a patient's condition qualifies this individual to obtain the prescription under the terms of the Plan."
South Carolina Public Employee Benefit Authority, Health Care Policy Committee meeting materials, October 23, 2024, effective October 2024 · source
"Caremark is the pharmacy benefits manager."
South Carolina Public Employee Benefit Authority, Prescription benefits · source
If the appeal fails, or you cannot wait
South Carolina 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 |
|---|---|
| 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. |
| PartnerRxSpan MDCheck availability | Multi-category telehealth that promises transparent pricing, then publishes no GLP-1 price on the page our link opens. |
| PartnerSnagRxCheck availability | Compounded semaglutide at $69 a month and tirzepatide at $119, the same at every dose, with no membership. Both are countdown sale prices, marked down from $299 and $399. Not available in Louisiana. |
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
- South Carolina Department of Health and Human Services, Pharmacy and Therapeutics Committee Meeting Minutes, effective November 2025 — Open the document
- South Carolina Healthy Connections Medicaid, Single Preferred Drug List, effective 01/01/2026, effective January 2026 — Open the document
- South Carolina Healthy Connections Medicaid, Single Preferred Drug List, effective 09/01/2026, effective September 2026 — Open the document
- South Carolina Healthy Connections Medicaid, GLP-1 Receptor Agonists and GLP-1/GIP Receptor Agonists Criteria, effective May 2026 — Open the document
- South Carolina Department of Health and Human Services, Pharmacy Services Provider Manual, effective July 2026 — provider.scdhhs.gov/internet/pdf/manuals/pharm/Manual.pdf
- South Carolina Department of Health and Human Services, Medicaid bulletins archive — www.scdhhs.gov/communications
- South Carolina Department of Health and Human Services, File an Appeal — www.scdhhs.gov/appeals/file-appeal