MedicaidCoverageHigh impact
MAB2025112402
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Family Medicine, Internal Medicine +3 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will stop covering GLP-1 receptor agonists (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 GLP-1 prior authorizations expire December 31, 2025, requiring new requests for any continued coverage.
Action Required
By December 31, 2025: Providers must submit new prior authorization requests for all patients currently on GLP-1 receptor agonists (Ozempic, Wegovy, Mounjaro, etc.) as all existing authorizations expire. Billing team must update PA requirements to reflect GLP-1s are NO LONGER COVERED for obesity/weight loss but still covered for diabetes and other conditions. Update encounter forms and EMR templates to alert providers that Saxenda is completely discontinued. Claims for GLP-1s without proper prior authorization will be denied after January 1, 2026.