North Carolina Medicaid: Updated coverage for GLP-1 medications
AI Summary
North Carolina Medicaid is reinstating coverage for GLP-1 medications (Wegovy, Zepbound, Saxenda) for weight management effective December 12, 2025. Wegovy is preferred, while Zepbound and Saxenda require prior authorization with step therapy or documented contraindication to Wegovy.
Action Required
By December 12, 2025: Billing team must update prior authorization workflows for GLP-1 weight management medications in NC Medicaid. Configure system to require step therapy documentation showing Wegovy trial/failure OR contraindication before approving Zepbound or Saxenda. Update clinical criteria at http://nctracks.nc.gov/content/public/providers/pharmacy/pa-drugs-criteria-new-format.html. Providers should assess patients for treatment gaps and appropriate starting doses.
Plan Types
Medicaid
States
NC
Specialties
endocrinology, family-medicine, internal-medicine, ob-gyn