State coverage
Texas 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
- Wegovy and Zepbound are covered, but obesity alone never qualifies — heart, liver or sleep apnea does.
- Appeal deadline
- 90 calendar days, from the effective date of the action or the notice date, whichever is later source
- Date read
- August 2026
Texas was missing from this site for two rounds because its own pharmacy sites answered us with 403 Forbidden. That was never Texas declining to publish. The state's servers screen for a full browser fingerprint rather than a user-agent string, and once the request carried one the same pages opened normally. We are writing that down because a blocked page and an absent page look identical from the outside, and treating the first as the second is how a site ends up printing something false about a state.
What Texas actually does is more specific than either of the labels usually applied to it. It covers Wegovy and it covers Zepbound. It also refuses both for obesity on its own. Wegovy runs through cardiovascular disease at 45 or over, or through non-cirrhotic liver disease with confirmed stage F2 to F3 fibrosis. Zepbound runs through moderate to severe sleep apnea with a measured apnea-hypopnea index of at least 15. Obesity appears in both as a box that also has to be ticked, never as the reason.
Two of these prior authorizations are unusual in a way worth knowing if you are in a managed care plan. Texas requires its plans to work a short list of clinical prior authorizations statewide, and Wegovy and Zepbound are two of the four on it. The state also says plainly that plans have to use its formulary, so this is one of the states where the answer above is the answer wherever you are enrolled.
Two things about Texas. The criteria are published by the state's prior-authorization contractor and linked from the Vendor Drug Program's own page, rather than sitting on a state domain — they are the state's criteria, published by its vendor. And whether a drug is covered lives only in the formulary search tool. None of the September 2026 manual chapters on outpatient drugs, prior authorization, managed care or appeals names a single GLP-1, so checking the manual will tell you nothing and could easily be mistaken for a no.
What we could verify for Texas
Wegovy's Texas criteria never open on obesity. The document walks a numbered logic: it first asks whether you are 45 or over, then whether you have a diagnosis of cardiovascular disease, and only then asks about "a diagnosis of obesity or overweight in past medical and/or pharmacy claims history." The other way in is liver disease — non-cirrhotic MASH with "moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis)," confirmed by biopsy or by a named non-invasive test within the last 180 days. An approval runs 365 days.
Texas Prior Authorization Program Clinical Criteria, Wegovy (Semaglutide), effective May 2026 · source
Zepbound goes through sleep apnea. The criteria ask whether you are 18 or over, then whether you have "a diagnosis of moderate to severe obstructive sleep apnea (OSA)," then whether you have "an apnea-hypopnea index (AHI) of at least 15 events per hour on polysomnography (PSG) or home sleep apnea test (HSAT)," and then about a diagnosis of obesity. An initial approval runs 180 days. To renew it you have to show results: "Has the client lost or maintained a loss of at least 5% from their baseline weight?"
Texas Prior Authorization Program Clinical Criteria, Zepbound (Tirzepatide), effective May 2026 · source
Being in a Texas managed care plan does not change the drug list. The Vendor Drug Program states that "HHSC requires managed care organizations to adhere to the Medicaid and CHIP formularies."
Texas Health and Human Services, Vendor Drug Program · source
It also does not change these two criteria. Texas requires its plans to run a specific short list of clinical prior authorizations, and the GLP-1 weight drugs are on it: "Clinical prior authorizations required by MCOs to perform for clients enrolled in Medicaid include the following: Hormonal Therapy Agents (PDF) Promethazine Agents (PDF) Wegovy (PDF) Zepbound (PDF)." Four are required statewide and two of them are these.
Texas Health and Human Services, Vendor Drug Program · source
Texas gives you 90 calendar days, and it measures from whichever of two dates is later. Its hearings handbook says: "The appellant has a right to file an appeal within 90 calendar days from the effective date of the action or from the notice of adverse action date, whichever is later." The same handbook lists "the denial of a prior authorization request" among the things you can appeal, and adds a note worth carrying: agency staff "may not prevent a client from filing an appeal because staff believe that the item, service or benefit is not subject to appeal," because the hearings officer decides that.
Texas Health and Human Services Commission, Fair and Fraud Hearings Handbook §1420, effective May 2025 · source
The Texas provider manual will tell you nothing about these drugs. Four chapters of the September 2026 edition — outpatient drug services, prior authorization, managed care and appeals — name no GLP-1 brand or molecule at all, and never use the terms GLP-1, weight loss or obesity, though prior authorization appears hundreds of times. Drug-level status in Texas lives in the formulary search and the criteria documents, not the manual, so checking the manual and finding nothing means nothing.
Texas Medicaid and Healthcare Partnership, Texas Medicaid Provider Procedures Manual, effective September 2026 · source
Texas is one of 33 states whose Medicaid gives the same answer: weight loss excluded; heart, liver or sleep apnea can qualify. Texas 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 Texas with the rest in the coverage matrix.
Regional insurers that sell plans in Texas and have their own page here, quoted from their own policy documents: Blue Cross and Blue Shield of Texas. The national insurers are on the insurance index.
If you work for the State of Texas
State employees aren't on Medicaid, so the answer above isn't yours. Your plan is the one the state buys for its workers: HealthSelect of Texas (ERS). Its pharmacy benefit runs through Express Scripts.
Weight loss excluded; Wegovy for heart risk with PA
HealthSelect excludes drugs used only for weight loss, naming Zepbound and Saxenda. Wegovy can be covered, with prior authorization, to cut heart-attack and stroke risk in adults with heart disease.
The plan excludes "Drugs prescribed and dispensed solely for the treatment of obesity, with an FDA Indication only for weight loss or for use in any program of weight reduction, weight loss, or dietary control ... Examples: Zepbound, Saxenda, Qsymia."
ERS / Express Scripts, Master Benefit Plan Document, HealthSelect of Texas Prescription Drug Program, effective September 2025 · source
"Wegovy, prescribed in combination with a reduced-calorie diet and increased physical activity, to reduce the risk of major adverse cardiovascular events (MACEs), may be covered for adults with established cardiovascular disease (CVD) and who are either obese or overweight. Participants will be required to meet Prior Authorization requirements."
ERS / Express Scripts, Master Benefit Plan Document, HealthSelect of Texas Prescription Drug Program, effective September 2025 · source
The plan "covers glucagon-like peptide-1 (GLP-1) medications when being used for an FDA-approved use, which is in addition to diet and exercise to improve glycemic (blood sugar) control in adults with type 2 diabetes mellitus."
ERS / Express Scripts, Master Benefit Plan Document, HealthSelect of Texas Prescription Drug Program, effective September 2025 · source
From the ERS board minutes: "Mr. Duran stated that at current prices that coverage was not sustainable as these are maintenance medications."
Employees Retirement System of Texas, Board of Trustees minutes, May 20, 2025 meeting, effective August 2025 · source
If the appeal fails, or you cannot wait
Texas 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 |
|---|---|
| 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. |
| PartnerRxSpan MDCheck availability | Multi-category telehealth that promises transparent pricing, then publishes no GLP-1 price 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
- Texas Prior Authorization Program Clinical Criteria, Wegovy (Semaglutide), effective May 2026 — Open the document
- Texas Prior Authorization Program Clinical Criteria, Zepbound (Tirzepatide), effective May 2026 — Open the document
- Texas Health and Human Services, Vendor Drug Program — Open the document
- Texas Health and Human Services, Vendor Drug Program — Open the document
- Texas Health and Human Services Commission, Fair and Fraud Hearings Handbook §1420, effective May 2025 — fhb.hhs.texas.gov/handbooks/fair-fraud-hearings-handbook/1400-submitting
- Texas Medicaid and Healthcare Partnership, Texas Medicaid Provider Procedures Manual, effective September 2026 — Open the document