Wyoming Medicaid and GLP-1 coverage

The exclusion applies to every plan and is one phrase long. Under "LEGEND DRUG EXCLUSIONS (ALL MEDICAID PLANS)," the Wyoming Medicaid Pharmacy Provider Manual lists "Anorexiant products" first, followed by "Androgenic or anabolic steroids used for weight gain," "Agents used to promote fertility," "Erectile dysfunction medications" and "Medications not approved by the FDA." The manual read was headed "April 15, 2026" and footed "Draft, Revision 27, April 15, 2026"; a search of all of it on 2026-09-03 returned no occurrence of obesity, weight loss, Wegovy or Zepbound, which is why the coverage that does exist has to be read off the drug list and criteria chart instead.

Wyoming Department of Health, Division of Healthcare Financing, Medicaid Pharmacy Provider Manual, effective April 2026 · source

Wegovy is on the drug list under a liver heading, with the heart route sent elsewhere. The class is "MASH (Metabolic-Associated Steatohepatitis)"; its approved agents are "WEGOVY (INJECTABLE)*" and "WEGOVY HD (INJECTABLE)*," with "REZDIFFRA" non-preferred, and the footnote reads: "*Wegovy injectables will require diagnosis of MASH. Please consult the Additional Therapeutics Clinical Criteria chart for more information regarding cardiovascular disease criteria." The list is headed "WYOMING MEDICAID Preferred Drug List (PDL) June 8, 2026" and states on its face that "Drug classes not included on this list are not managed through a Preferred Drug List (PDL). HOWEVER, THIS EXCLUSION IS NOT A GUARANTEE OF PAYMENT OR COVERAGE."

Wyoming Department of Health, Wyoming Medicaid Preferred Drug List, effective June 2026 · source

Zepbound has a class of its own on the drug list and the whole rule is printed in it. Under the obstructive sleep apnea GLP-1 agonist class, the single agent is "ZEPBOUND," and the criteria read: "Client must have diagnosis of moderate to severe obstructive sleep apnea. Will be approved for obese adults with an AHI (Apnea-Hypopnea Index) of greater than 15 as evidenced by sleep study within the prior 12 months. Prior authorization will be required again at 6 months to show at least 5% weight loss. Prior authorization will be required again at 12 months to demonstrate improvement in obstructive sleep apnea."

Wyoming Department of Health, Wyoming Medicaid Preferred Drug List, effective June 2026 · source

The criteria chart carries the heart route, and it is two lines long. Under "WEGOVY": "Client must have BMI of 27 or higher with cardiovascular disease defined as prior myocardial infarction, prior stroke, or peripheral artery disease." The chart's Zepbound entry repeats the sleep apnea sequence and adds the twelve-month test in full: improvement "as evidenced by another sleep study," and "Additional approvals will require continued documentation of improvement in member weight and overall health." The chart is headed "ADDITIONAL THERAPEUTIC CLASSES WITH CLINICAL CRITERIA" and dated "Last Updated June 8, 2026."

Wyoming Department of Health, Wyoming Medicaid Additional Therapeutic Classes with Clinical Criteria, effective June 2026 · source

The diabetes-indicated drugs are a separate class with a metformin gate. Under "INCRETIN MIMETICS (GLP-1 RECEPTOR AGONISTS)," the preferred agents are exenatide, "OZEMPIC (tablets)," RYBELSUS, TRULICITY and VICTOZA, and the rule is: "Trial and failure of metformin greater than or equal to a 90 day supply in the last 12 months will be required before approval can be given for a preferred agent unless ASCVD or risk factors are present, in which case the trial of metformin is waived. A 90 day trial of failure of the preferred agent is required before approval can be given for a non-preferred agent." MOUNJARO and the injectable OZEMPIC are non-preferred, and dosage limits are stated for Ozempic and Victoza. Neither Wegovy nor Zepbound appears in this class.

Wyoming Department of Health, Wyoming Medicaid Preferred Drug List, effective June 2026 · source

A pharmacy denial in Wyoming has a step before the hearing, on its own clock. The pharmacy manual states that "If a PA is denied, in accordance with Chapter 10 of the Medicaid Rules, clients or the prescriber may request reconsideration of the decision to deny the request for prior authorization within twenty (20) business days of the receipt of the notice of denial," that the request "shall be made in accordance with the reconsideration provisions of Chapter 3 of the Medicaid Rules," and that only afterwards "the client may request an administrative hearing as set forth in Chapter Four of the Wyoming Medicaid Rules." It adds a warning: "The failure to request reconsideration in a timely manner and acceptable method as described in Chapter Four of the Wyoming Medicaid Rules prevents an administrative hearing."

Wyoming Department of Health, Division of Healthcare Financing, Medicaid Pharmacy Provider Manual, effective April 2026 · source

The hearing itself is twenty business days, counted from when the state mailed the notice. Chapter 4 of the Wyoming Medicaid Rules provides at Section 7(a) that "A client's request for a hearing shall be submitted electronically via email to the Department, made verbally to the Department, mailed to the Department via certified mail, return receipt requested, or personally delivered to the Department within twenty (20) business days after the mailing of the notice of adverse action." The same chapter establishes the right — "A client has a right to a hearing if eligibility or services are denied, reduced, terminated or suspended" — requires notice of an adverse action "at least ten (10) business days before the effective date," and gives the Department "ten (10) business days following the receipt of the request" to say in writing whether it has been accepted. The rule's cover page records "Effective Date: 03/24/2020 to Current."

Wyoming Department of Health, Medicaid Rules Chapter 4: Medicaid Administrative Hearings, effective March 2020 · source