State coverage
Tennessee Medicaid and GLP-1 coverage
Medicaid, for obesity: Covers for weight loss. 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
- Covered since August 1, 2025. Wegovy and Zepbound are preferred; older appetite drugs need no approval.
- Appeal deadline
- Not published — both TennCare rule chapters were obtained in full, along with the pharmacy notices and the PA forms, and none of them states a filing window for a pharmacy denial. Federal ceiling: no more than 90 days.
- Date read
- September 2026
Tennessee added this benefit rather than removing it, and it did so with an unusually open door at the low-cost end. The older appetite and absorption drugs are preferred and, on the state's own form, need no prior authorization at all — a quantity limit and nothing else. That is rare enough to be worth stating plainly, because most states on this site gate every anti-obesity drug behind a form.
The GLP-1 drugs are a different tier. Two are preferred and both need approval; two more sit in the non-preferred column and need a documented failure of a preferred product before they will be considered. So the structure rewards starting cheap, and the paperwork burden rises with the price of the drug.
One feature has no equivalent on any other state page here. Tennessee's three managed care plans each run wraparound programs for members taking these drugs — dietitian counseling, behavioral health support, health coaching — and the state published a notice naming them. Whatever else that is, it is a state treating the prescription as one part of a program rather than the whole of it.
Tennessee does not publish a filing deadline for a pharmacy denial. Both TennCare rule chapters are on this page, along with the pharmacy notices and the prior authorization forms, and none of them states a window — the rules mention appeals only in passing. So the date on your notice is the one that counts. The federal ceiling that applies everywhere is on the procedures page.
What we could verify for Tennessee
Tennessee started covering these drugs on a dated notice, for adults and children alike. Its provider notice states: "Effective August 1, 2025, medications for obesity management will be covered for both adults (ages 21 and over) and children per medication label subject to interim prior authorization (PA) criteria and quantity limits." The pharmacy benefit is administered for TennCare by OptumRx, whose support center the notice directs providers to.
State of Tennessee, Division of TennCare (Provider Notice, Obesity Management Agents), effective August 2025 · source
A whole tier of anti-obesity drugs carries no prior authorization requirement in Tennessee. The notice lists as "preferred without PA" benzphetamine, diethylpropion, Lomaira, orlistat, phendimetrazine, phentermine and phentermine/topiramate, each with a quantity limit. The state's own prior authorization form repeats this, heading that block "Appetite and Absorption Agents (No PA Required*)" and adding Xenical to it. The asterisk carries a caution: "These agents are intended for short-term obesity management; and benefits should outweigh risks. Abrupt cessation should be avoided. Tapering is recommended."
State of Tennessee, Division of TennCare (Weight Management Agents Prior Authorization Form, revision date 08/2026), effective August 2026 · source · provider notice
The GLP-1 tier is split preferred against non-preferred, and the split decides how much you have to prove. The form's "GLP-1 Weight Management Agents" table lists as preferred "Wegovy® injection" and "Zepbound® single dose prefilled pen," both flagged for prior authorization and a quantity limit, against non-preferred "liraglutide (weight management)" and "Saxenda®," flagged the same way. For the non-preferred pair the form asks whether "the patient failed, had an adverse event or intolerance to a preferred product," and for liraglutide specifically whether the patient failed or could not tolerate Saxenda.
State of Tennessee, Division of TennCare (Weight Management Agents Prior Authorization Form, revision date 08/2026), effective August 2026 · source
The entry test for a GLP-1 is a body mass index floor with a comorbidity alternative, and it is age-banded. The form asks for records supporting one of: "For patients < 18 years of age and weight > 95th percentile standardized for age and sex" or, for patients over 18, "Initial BMI > 30 kg/m2" or "BMI > 27 kg/m2 AND patient has a weight related comorbidity (e.g., hypertension, dyslipidemia, diabetes, coronary heart disease, MASH/NASH, obstructive sleep apnea)." It also requires the prescriber to attest that the patient "is participating in complementary nutritional and lifestyle changes," and asks whether the drug will be combined with other obesity medications or with another GLP-1 receptor agonist, and about any personal or immediate family history of medullary thyroid carcinoma or MEN2.
State of Tennessee, Division of TennCare (Weight Management Agents Prior Authorization Form, revision date 08/2026), effective August 2026 · source
Tennessee wraps the prescription in plan-run services and published a notice saying so. "Each of TennCare's three Managed Care Organizations (MCOs) are offering wraparound services to support patients utilizing GLP-1 Agonists for weight management. The MCOs services include nutrition/dietician counseling, behavioral health support, case management/health coaching, and digital engagement." The three named are BlueCare, UnitedHealthcare Community Plan and Wellpoint. One of them describes an "Obesity Model of Care" developed "to support TennCare members with obesity, particularly those using incretin-based therapies, by pairing pharmacotherapy with evidence-based wraparound supports." Which services you can reach depends on which plan you are in.
State of Tennessee, Division of TennCare (Provider Notice, Weight Management MCO Wraparound Services), effective August 2026 · source
The preferred drug list is still being rebuilt class by class, so a drug's status is a moving target rather than a settled fact. TennCare's August 2026 notice states: "TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are taking may be considered non-preferred agents in the future." It directs readers to the OptumRx TennCare site for the clinical criteria behind each class.
State of Tennessee, Division of TennCare (Provider Notice, Preferred Drug List effective August 1, 2026), effective August 2026 · source
Tennessee is one of 10 states whose Medicaid gives the same answer: pay for these drugs for weight loss, with prior authorization. Tennessee 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 Tennessee with the rest in the coverage matrix.
If you work for the State of Tennessee
State employees aren't on Medicaid, so the answer above isn't yours. Your plan is the one the state buys for its workers: Tennessee State Group Insurance Program (Partners for Health), State and Higher Education plans. Its pharmacy benefit runs through CVS Caremark.
Covered with PA; 25% coinsurance
Tennessee's state employee plans cover weight-loss drugs, including Wegovy, Zepbound and Foundayo, with prior authorization. You pay 25% coinsurance in every plan, and fills are limited to a 30-day supply.
"Medications prescribed for obesity: Members in all plans will pay 25% coinsurance for medications prescribed for weight loss. These medications are limited to a 30-day supply per fill."
Tennessee Department of Finance and Administration, Benefits Administration (Partners for Health), Pharmacy page · source
"All Partners for Health medical plans include pharmacy benefits, managed by CVS Caremark."
Tennessee Department of Finance and Administration, Benefits Administration (Partners for Health), Pharmacy page · source
The 2026 member cost chart shows 25% for "30-Day Supply Medications Prescribed for Obesity" in each plan column, with "N/A - no network" out of network.
Tennessee Partners for Health, 2026 Health Plan Comparison of Member Costs, State and Higher Education, effective January 2026 · source
Under "ANTI-OBESITY AGENTS", the State of Tennessee formulary lists Wegovy, Zepbound and Foundayo at tier 2 and Saxenda at tier 3, each marked "PA; Weight Loss" and "Coinsurance Applies".
CVS Caremark, Prescribing Guide - Standard Control for Clients with Advanced Control Specialty Formulary for State of Tennessee, effective October 2026 · source
The 2027 chart keeps the same line: "30-Day Supply Medications Prescribed for Obesity" at 25% in each plan.
Tennessee Partners for Health, 2027 Health Plan Comparison of Member Costs, State and Higher Education, effective January 2027 · source
If the appeal fails, or you cannot wait
Tennessee Medicaid pays for these drugs for weight loss with prior authorization, so a denial there is worth appealing before anything else. If the appeal fails, or you can't wait for it, cash-pay telehealth is the fallback, not the bargain: you pay the whole cost yourself.
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 |
|---|---|
| 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. |
| PartnerSkinnyRxCheck availability | Compounded semaglutide and tirzepatide injections at $99 for the first month, tablets at $149 and $199. No second-month price is printed for any of them. |
| PartneryourEraCheck availability | Compounded semaglutide at $79.20 a month and tirzepatide at $159.20. Both are six-month-plan prices, and the plan carries a six-month commitment. |
| PartnerbmiMDCheck availability | Compounded semaglutide from $119 a month and tirzepatide from $179. Both are limited-time sale prices, marked down from $228.60 and $349.20. |
| PartnerCollectiveCheck availability | Compounded semaglutide at $59 a month and tirzepatide at $69 at every dose, plus a required $199 yearly membership. It's free for 21 days, then billed for the full year at once, and it isn't refundable. |
| PartnerSprout HealthCheck availability | Compounded semaglutide from $149 a month and tirzepatide from $199, on plans that renew automatically. Also lists brand Wegovy and Zepbound. |
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
- State of Tennessee, Division of TennCare (Provider Notice, Obesity Management Agents), effective August 2025 — Open the document
- State of Tennessee, Division of TennCare (Weight Management Agents Prior Authorization Form, revision date 08/2026), effective August 2026 — Open the document
- State of Tennessee, Division of TennCare (Provider Notice, Weight Management MCO Wraparound Services), effective August 2026 — Open the document
- State of Tennessee, Division of TennCare (Provider Notice, Preferred Drug List effective August 1, 2026), effective August 2026 — Open the document