Does New York Medicaid cover Wegovy and Zepbound in 2026?
No, not for obesity alone. As of Oct 23, 2026, New York Medicaid does not cover Wegovy or Zepbound when used only for weight loss.
Not covered for obesity alone Checked Oct 23, 2026 PDL revised Oct 22, 2026
Coverage of GLP-1 drugs for obesity alone under New York’s fee-for-service Medicaid drug rules, as the state publishes them. The plan decides each request.
New York’s rule
In plain words
Not covered for obesity alone
No obesity-only route. Wegovy (heart disease) and Zepbound (sleep apnea) need BMI 40 or more; two treatment attempts per lifetime.
Changed Oct 22, 2026: the heart-disease (Wegovy) and sleep apnea (Zepbound) routes now need a BMI of 40 or more, with two treatment attempts per lifetime.
Source
State Medicaid pharmacy vendor (Prime Therapeutics): NYRx PDP/PDL, revised Oct 22, 2026 (opens in new tab). Checked Oct 23, 2026.
Federal Medicaid law lets a state exclude these drugs only “when used for anorexia, weight loss, or weight gain”; their use for type 2 diabetes is not on that list, though a state may require prior authorization. Social Security Act §1927(d)(1)(A) and (d)(2)(A), 42 U.S.C. 1396r-8(d) (opens in new tab).
What changed
- Oct 22, 2026: New York’s heart-disease (Wegovy) and sleep apnea (Zepbound) routes now need a BMI of 40 or more, with two treatment attempts per lifetime; no obesity-only route. NYRx PDP/PDL, revised Oct 22, 2026 (opens in new tab)
Next steps
Where to go from here
Neighbouring states
Questions this page answers
Does New York Medicaid cover Wegovy and Zepbound for weight loss?
No, not for obesity alone. As of Oct 23, 2026, New York Medicaid does not cover Wegovy or Zepbound when used only for weight loss. No obesity-only route. Wegovy (heart disease) and Zepbound (sleep apnea) need BMI 40 or more; two treatment attempts per lifetime.
Has New York’s rule changed recently?
Oct 22, 2026: New York’s heart-disease (Wegovy) and sleep apnea (Zepbound) routes now need a BMI of 40 or more, with two treatment attempts per lifetime; no obesity-only route.
Where does this information come from?
From New York Medicaid’s pharmacy vendor (Prime Therapeutics): NYRx PDP/PDL, revised Oct 22, 2026, read on Oct 23, 2026. Federal Medicaid law lets a state exclude these drugs only “when used for anorexia, weight loss, or weight gain”; their use for type 2 diabetes is not on that list, though a state may require prior authorization.
Kymata Health reads each state’s own Medicaid documents. See every state on the map.