MedicaidCoverageHigh impact
25-1414 Medi-Cal Rx Coverage Changes for GLP-1 Medications
Health Net·CA · Family Medicine, Internal Medicine, Endocrinology +1 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Medi-Cal Rx will remove coverage for Wegovy, Zepbound, and Saxenda for weight loss indications, with very limited exceptions. Other GLP-1 medications will only be covered for type 2 diabetes, not weight loss, and will require Code I diagnosis restrictions.
Action Required
Before January 1, 2026: Billing team must review all current GLP-1 medication prescriptions and identify patients using Wegovy, Zepbound, or Saxenda for weight loss who will lose coverage. Providers must plan alternative therapies for affected patients. Update billing system to flag that claims for these medications will be denied with Reject Code 70 or 80 after the effective date. For other GLP-1 medications (Ozempic, Rybelsus, Mounjaro, Victoza, Byetta, Bydureon, Trulicity), ensure proper Code I diagnosis documentation for type 2 diabetes or claims will be denied.