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Harvard Pilgrim Health CareMedicaid · Coverage · Medical Policy · MA · Endocrinology, Family Medicine, Internal Medicine +2 moreHigh impact

MassHealth coverage change: anti-obesity medications

Act
by Feb 17, 2026
Effective date
Jul 1, 2026
Identified
Jun 20, 2026

Summary

Effective July 1, 2026, MassHealth-affiliated plans (Tufts Health Together, Tufts Health Plan Senior Care Options, and Tufts Health One Care) will no longer cover anti-obesity medications including Wegovy, Zepbound, Saxenda, and others when used specifically for obesity treatment. GLP-1 medications will still be covered for diabetes, cardiovascular disease, MASH, and sleep apnea but will require new prior authorizations.

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What to do

by Feb 17, 2026 · 3 steps
01Billing team must identify all patients on anti-obesity medications covered by Tufts Health plans and coordinate with providers to either switch patients with diabetes/prediabetes to antidiabetic GLP-1s or resubmit prior authorizations for approved non-obesity indications (cardiovascular disease, MASH, sleep apnea).
02Before June 30, 2026: Update billing system to flag these medications as requiring prior authorization for non-obesity indications only.
03For Tufts Health Together members, prioritize Wegovy over Zepbound as preferred drug.
If missed: Failure to obtain proper prior authorization will result in claim denials after July 1, 2026.

Original notice

MassHealth coverage change: anti-obesity medications
point32health.org · Always check the source before changing claims.
View original ↗

Related changes

See all Harvard Pilgrim Health Care changes →
Coverage of GLP-1s for Tufts Health RITogether membersHighEffective Oct 1, 2026 · Provider NewsletterMassHealth coverage change: anti-obesity medicationsHighEffective Jul 1, 2026 · Medical PolicyBrowse every Harvard Pilgrim Health Care change in the policy list

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