Upcoming Medi-Cal Rx GLP-1 Coverage Changes: What Patients Need to Know About Ozempic, Wegovy, and More in 2026
Upcoming Removal of Selected GLP-1 Drugs from Medi-Cal Rx
Effective January 1, 2026, California’s Medi-Cal Rx program will remove certain medications from its contract drug list. The following drugs will no longer be eligible for coverage for weight loss or weight loss-related indications, regardless of any previously approved prior authorizations:
· Wegovy
· Zepbound
· Saxenda
All prior authorizations for these medications will be denied for weight loss purposes. However, there are specific exceptions for certain medical conditions:
· Wegovy: Prior authorization requests will be considered only for patients with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) or cardiovascular disease.
· Zepbound: Prior authorization requests will be considered when the drug is used for obstructive sleep apnea (OSA).
Other GLP-1 Medications
The following GLP-1 drugs will continue to require a diagnosis of type 2 diabetes for coverage. Starting January 1, 2026, these medications will no longer be covered for weight loss or weight loss-related indications:
· Ozempic
· Rybelsus
· Mounjaro
· Victoza
· Byeta
· Bydureon
· Trulicity
Ensuring Continuation of Therapy
If you are currently prescribed any GLP-1 medication for an approved indication, it is important to ensure your prescriber includes the appropriate diagnosis code (ICD-10) when submitting your prescription. Without the ICD-10 code, Modern Drug cannot process your claim, which will result in your provider being contacted and potential delays in receiving your medication.
For those who have been using these drugs specifically for weight loss, it is recommended to discuss alternative treatment options with your healthcare provider.
Thank you for trusting Modern Drug, your reliable pharmacy in Fresno, California, for all your medication and healthcare needs.