What was already in effect?

Colorado — October 2026

The pharmacy benefit's own criteria document restates it as a class. Appendix P lists a class headed "ANOREXIANTS" and says "Medications prescribed for use for weight loss are not a covered benefit," naming Adipex-P, Belviq, Contrave, Lomaira, phentermine, Qsymia, Saxenda and Xenical. The version read carries "DUR Quarterly Revisions Effective 10/01/2026" and "Revised 08/31/2026" on its face.

Colorado Department of Health Care Policy & Financing, Appendix P (Health First Colorado Pharmacy Benefit) · source · read September 2026 · Colorado page

Colorado — October 2026

The drug list repeats the rule in the words that matter: "Note: Prior Authorization for GLP-1 analogues prescribed solely for weight loss will not be approved." The same note appears against the amylin class. So the drugs are on the list, and the reason is what is refused.

Colorado Department of Health Care Policy and Financing, Preferred Drug List, effective October 1, 2026 · source · read September 2026 · Colorado page

Colorado — October 2026

The sleep apnea route is the widest door and it is a long list. Zepbound may be approved where the member is 18 or older, has "a documented diagnosis of moderate to severe obstructive sleep apnea (OSA)," has "a BMI ≥30 kg/m2 indicating obesity documented in medical chart notes," has a diagnosis confirmed by an FDA-approved sleep test, has had a polysomnogram "with a documented result of Apnea-Hypopnea Index (AHI) ≥15 events/hour," is not pregnant or planning to be, is prescribed "by or in consultation with a neurologist, pulmonologist, otolaryngologist, or other sleep medicine specialist," is engaged in diet and exercise, and "has failed a 6-month trial of continuous positive airway pressure (CPAP) or has a contraindication to the use of PAP therapy." Reauthorization for a year needs an in-person re-evaluation and documented clinical improvement.

Colorado Department of Health Care Policy and Financing, Preferred Drug List, effective October 1, 2026 · source · read September 2026 · Colorado page

Colorado — October 2026

The cardiovascular route turns partly on a diagnosis you must NOT have. Wegovy may be approved where the member is 18 or older, "has established cardiovascular disease (history of myocardial infarction, stroke, or symptomatic peripheral arterial disease) and either obesity or overweight (defined as a BMI ≥25 kg/m2)," AND "does not have a diagnosis of Type 2 diabetes," and where the drug is prescribed to reduce cardiovascular events. A third route covers GLP-1s FDA-indicated for MASH at stage F2 to F3 fibrosis, prescribed by or with a named specialist.

Colorado Department of Health Care Policy and Financing, Preferred Drug List, effective October 1, 2026 · source · read September 2026 · Colorado page

Colorado — October 2026

The last change eased access inside the sleep apnea route. The September 2026 provider bulletin states that "Effective October 1, 2026, the Zepbound multidose KwikPen formulation will be changed to preferred status with criteria listed on the Preferred Drug List (PDL). The weekly single-use Zepbound injection pens will remain non-preferred," and that "Members with current prior authorization (PA) approval on file for the weekly single-use Zepbound pen formulation will automatically receive PA approval for the preferred Zepbound KwikPen to ease transition to the preferred product."

Colorado Department of Health Care Policy & Financing, Provider Bulletin B2600542, September 2026 · source · read September 2026 · Colorado page

Colorado — October 2026

Colorado's drug list says on its own face that it does not reach every member: "The PDL applies to Medicaid fee-for-service members. It does not apply to members enrolled in Rocky Mountain Health HMO or Denver Health Medicaid Choice." Those two plans publish their own formularies, which we did not open. Nothing on this page describes what they cover.

Colorado Department of Health Care Policy and Financing, Preferred Drug List, effective October 1, 2026 · source · read September 2026 · Colorado page

Michigan — September 2026

The criteria document puts numbers on it. For adults, the prescriber attests to "an initial body mass index (BMI) classified as morbidly obese (e.g., baseline BMI ≥ 40 kg/m2 or greater)." Before that, there must be trial and failure with all five types of preferred non-GLP-1 agents — the document names benzphetamine, diethylpropion, orlistat products, phendimetrazine and phentermine — or a contraindication or unacceptable side effects across all five.

Michigan Department of Health and Human Services · source · read August 2026 · Michigan page

Michigan — September 2026

Approval runs six months at a time, initial and renewal alike, and keeping it requires results: the prescriber must document "that the patient has maintained a weight loss of ≥ 5% from baseline weight at initiation of therapy." There is also a separate, tighter gate for people who started before the rules changed — at first renewal they must be shown to have met the new morbid-obesity, failed-interventions and avert-surgery tests as of when they began.

Michigan Department of Health and Human Services · source · read August 2026 · Michigan page

Texas — September 2026

We read four chapters of the Texas Medicaid Provider Procedures Manual dated September 2026 — outpatient drug services, prior authorization, managed care, and appeals — and searched all four for every GLP-1 brand and molecule in scope, and for the terms GLP-1, weight loss and obesity. Not one of them appears anywhere in those chapters, while prior authorization appears hundreds of times, so the search was working. In Texas the manual is not where drug-level status lives; the formulary search and the criteria documents are.

Texas Medicaid and Healthcare Partnership, Texas Medicaid Provider Procedures Manual · source · read August 2026 · Texas page

Arizona — September 2026

The drug-level answer is in the prior authorization criteria, not the list. The Wegovy guideline, effective February 1, 2026, has one line under the diagnosis "Weight Loss": "Wegovy when used for the treatment of weight loss is excluded and is to be denied as a benefit exclusion." Its cardiovascular pathway then requires that you are 45 or older, have "BMI (body mass index) greater than or equal to 30 kg/m2," have established cardiovascular disease from a list of diagnosis codes, are using the drug "in combination with a reduced calorie diet and increased physical activity," and do not have diabetes; an approval runs 6 months. The general GLP-1 guideline for the diabetes drugs, effective June 1, 2026, includes the criterion "Drug is not being used for weight loss" and a note that a request "to treat appetite suppression/weight loss or improve conditions caused by obesity (i.e., Zepbound for OSA)" is to be denied "for Plan Exclusion." The criteria file is the one the state's pharmacy page labels effective September 1, 2026.

Arizona Health Care Cost Containment System, Fee-For-Service Program Pharmacy Prior Authorization Criteria (Wegovy guideline GL-509188; GLP-1 Agonists guideline GL-620203) · source · read September 2026 · Arizona page

Mississippi — September 2026

One drug list covers everybody, and the state says so rather than leaving it to be inferred. The preferred drug list page states: "The Mississippi Division of Medicaid (DOM)'s universal preferred drug list (PDL) is for all Medicaid, MississippiCAN (MSCAN) and Children's Health Insurance Program (CHIP) beneficiaries." The prior authorization form carries the same scope in its header line, addressed to Medicaid fee-for-service, MSCAN and MSCHIP members together.

Mississippi Division of Medicaid · source · read September 2026 · Mississippi page

Utah — September 2026

The drug list now states the class rule in one line. Under its GLP-1 Agonists heading the preferred drug list says these drugs "are only covered for type 2 diabetes mellitus" and that "All GLP-1 Agonists are mutually exclusive with each other. Only one GLP-1 per month may be covered." Saxenda, Wegovy and Zepbound appear nowhere on a drug line of that list — they survive only as an entry in its index of prior authorization forms.

Utah Medicaid, Fee-for-Service Preferred Drug List, effective September 1, 2026 · source · read September 2026 · Utah page