Does Molina Healthcare cover GLP-1s?
What Molina Healthcare says on its own pages (molinahealthcare.com), sorted by topic. Your own plan documents decide what you get.
Read Sep 28, 2026. Each line names the plan type it applies to.
Does it cover GLP-1s for weight loss?
- Molina Healthcare of Illinois (Medicaid) provider formulary page says some drugs are never covered, such as drugs for weight loss.Medicaid (IL):
Some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss.
molinahealthcare.com, Sep 29, 2026 - Passport by Molina Healthcare (Kentucky Medicaid) GLP-1 criteria notice dated 5/31/2024 states that drugs used for weight loss are excluded from coverage.Medicaid (KY):
*Drugs used for anorexia, weight loss, or weight gain are excluded from coverage.
molinamarketplace.com, Sep 29, 2026
Prior authorization criteria
- Molina Healthcare of Virginia (Medicaid) provider forms page lists a service authorization form for weight-loss management, updated September 2024.Medicaid (VA):
Weight Loss Management SA Form -- updated September 2024
molinahealthcare.com, Sep 29, 2026 - Molina’s Marketplace provider “Drug Lists and Policies” page (Nevada) lists a Wegovy policy titled with “NC” (the page does not define NC; the policy itself is a PDF).Individual (ACA) plans:
Wegovy (semaglutide) NC C27682-A
molinahealthcare.com, Sep 29, 2026 - The same Marketplace page lists a Zepbound policy titled with “NC” (not defined on the page; the policy is a PDF).Individual (ACA) plans:
Zepbound (tirzepatide) NC C29112-A
molinahealthcare.com, Sep 29, 2026
Heart risk (Wegovy)
- Molina Healthcare of Virginia (Medicaid) provider forms page lists a service authorization form for GLP-1 RAs for cardiovascular risk reduction (September 2024).Medicaid (VA):
GLP-1 RAs for Cardiovascular Risk Reduction SA Form -- September 2024
molinahealthcare.com, Sep 29, 2026
Type 2 diabetes
- Passport by Molina Healthcare (KY Medicaid) notice dated 5/31/2024: starting July 1, 2024, prior authorization criteria changed for the listed GLP-1 medications.Medicaid (KY):
Beginning July 1, 2024, the mediations below will have a change to prior authorization criteria.
molinamarketplace.com, Sep 29, 2026 - In that KY Medicaid notice, the preferred-with-PA GLP-1 agents are Byetta, Ozempic, Trulicity and Victoza (with the listed PA/QL codes).Medicaid (KY):
Byetta CC, QL, Ozempic AE, CC, QL, Trulicity CC, QL, Victoza CC, QL.
molinamarketplace.com, Sep 29, 2026 - KY Medicaid criteria require a type 2 diabetes diagnosis confirmed by clinical documentation (ICD-10 T2DM diagnosis or qualifying A1c).Medicaid (KY):
• Diagnosis of Type II Diabetes Mellitus (T2DM) confirmed with clinical documentation (e.g., progress note) of one of the following: o ICD-10 diagnosis of T2DM; OR
molinamarketplace.com, Sep 29, 2026 - KY Medicaid GLP-1 (diabetes) approval duration is 6 months per the notice.Medicaid (KY):
Approval Duration: 6 months
molinamarketplace.com, Sep 29, 2026
How to check your own plan
- Molina Illinois Medicaid offers a preferred drug list search tool (lead-in to a list: search by name/class, find generics, see limits and PA).Medicaid (IL):
Use our preferred drug list search tool to:
molinahealthcare.com, Sep 29, 2026 - The Illinois PDL search tool shows whether a medicine has quantity limits, age limits, or requires prior authorization.Medicaid (IL):
See if your medicine has quantity limits, has age limits, or requires Prior Authorization.
molinahealthcare.com, Sep 29, 2026 - Molina Medicare’s Texas pharmacy page gives the Pharmacy team phone number, (800) 665-3086 (TTY 711), 7 days a week.Medicare:
You can contact our Pharmacy team at (800) 665-3086, TTY 711, 7 days a week,
molinahealthcare.com, Sep 29, 2026
What we could not confirm
- No web page from Molina Healthcare that we could read covers: does it depend on your employer or plan; sleep apnea (zepbound); recent changes.
- More detail, such as exact BMI cutoffs, is in 7 PDF documents from Molina Healthcare, which we have not opened.
Next steps
- Prior authorization and appeal letter templates
- Can you use the maker's savings card with your coverage?
- If it is not covered: the lowest verified cash prices
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