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Wisconsin Medicaid (ForwardHealth)Medicaid · Prior Auth · Pharmacy · WI · Pharmacy, Dermatology, Gastroenterology +8 moreHigh impact

July 2026 Preferred Drug List Changes and Other Pharmacy Policy

Effective date
Jul 1, 2026
Identified
Aug 26, 2026

Summary

Effective July 1, 2026, ForwardHealth adds weight management agents as a new Preferred Drug List class, with Foundayo and Zepbound as preferred drugs, but prior authorization is required for all weight management agents and only one weight management agent per member at a time is approved. Nine anti-obesity drugs will no longer be covered on that date: benzphetamine, diethylpropion, orlistat, phendimetrazine, phentermine, phentermine/topiramate, Evekeo (for obesity), Saxenda, and Xenical. Revised PA forms are required for several drug classes, and ForwardHealth will return PA requests that are not submitted on the revised forms.

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What to do

Action · 7 steps
01Already effective July 1, 2026: Prescribers or their designees must request PA for weight management agents, including Foundayo and Zepbound, on the Prior Authorization Drug Attachment for Weight Management Agents form dated 07/2026, through the DAPO Center, the Portal, fax, or mail, and must retain a completed copy of that form and the supporting documentation.
02Pharmacy providers may not request PA for weight management agents.
03Weight management PA requires a BMI of 30 or greater, or a BMI of 27 to less than 30 with two or more listed risk factors, and the member must agree to a reduced-calorie diet and increased physical activity.
04Pharmacy providers must use the revised 07/2026 forms for PA requests for non-preferred cytokine and CAM antagonist drugs for Crohn's disease, ulcerative colitis, psoriasis, rheumatoid arthritis, juvenile idiopathic arthritis, and psoriatic arthritis, for Voquezna tablets, and for non-preferred proton pump inhibitors, and ForwardHealth will return requests not submitted on those forms.
05The buprenorphine PA/PDL form (F-00081) and the PPI orally disintegrating tablets PA/PDL form (F-00433) are discontinued and will no longer be accepted.
06Buprenorphine tablets without naloxone are now preferred and no longer require PA, and Copaxone 20 mg and Copaxone 40 mg will require brand medically necessary PA.
07ForwardHealth will honor PA requests approved Previously due July 1, 2026 (date passed; verify current applicability) until they expire or the approved days supply is used up.

Original notice

July 2026 Preferred Drug List Changes and Other Pharmacy Policy
forwardhealth.wi.gov · Always check the source before changing claims.
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Related policy hubs

Wisconsin Medicaid (ForwardHealth) policiesWI policy changesPharmacyDermatologyGastroenterologyEndocrinologyRheumatologyNephrologyNeurologyPulmonologyENT (Ear, Nose & Throat)Allergy & ImmunologyPediatrics

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