MedicaidCoverageHigh impact
MAB2025112402
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will end coverage for GLP-1 receptor agonist drugs (like Ozempic, Wegovy) for obesity treatment starting January 1, 2026, though these drugs remain covered for diabetes and other approved conditions with prior authorization. All existing prior authorizations for GLP-1 drugs expire December 31, 2025, requiring new requests for any continued use.
Action Required
By December 31, 2025: Notify all providers that existing prior authorizations for GLP-1 receptor agonists expire and new requests must be submitted for patients continuing these medications for diabetes or other non-obesity indications. Update billing system to flag that GLP-1 drugs (Ozempic, Wegovy, Saxenda, etc.) are no longer covered for obesity treatment under Pennsylvania Medicaid starting January 1, 2026. Train staff that Saxenda will not be covered for any indication. Claims for GLP-1 drugs for obesity will be denied without coverage.