CountyCare does cover GLP-1 medications, but only when they are prescribed to treat type 2 diabetes and only after prior authorization. The plan does not cover GLP-1s prescribed for weight loss.1CountyCare. Benefits
Which GLP-1s Are Covered for Type 2 Diabetes
CountyCare’s clinical policy lists several GLP-1 receptor agonists that can be authorized for members with a type 2 diabetes diagnosis: semaglutide (Ozempic and Rybelsus), tirzepatide (Mounjaro), dulaglutide (Trulicity), liraglutide (Victoza), exenatide (Byetta), and the combination products Xultophy (liraglutide/insulin degludec) and Soliqua (insulin glargine/lixisenatide).2ILYouthCare (Centene). Clinical Policy: GLP-1 Receptor Agonists
Not all of them are equally easy to get. Illinois Medicaid’s statewide preferred drug list, which CountyCare follows, designates Trulicity, liraglutide, Victoza, and Rybelsus (with prior authorization) as preferred. Ozempic and Mounjaro are non-preferred.3Illinois Department of Healthcare and Family Services. Illinois Medicaid Preferred Drug List In practice, that means a prescriber usually has to show the member tried a preferred drug first before CountyCare will approve a non-preferred one.
Weight Loss Is Not Covered
CountyCare’s member benefits page states that weight loss drugs are not covered by Medicaid.1CountyCare. Benefits The clinical policy repeats the point: “Weight loss is a benefit exclusion and is not a covered benefit.”2ILYouthCare (Centene). Clinical Policy: GLP-1 Receptor Agonists Wegovy (semaglutide for chronic weight management) and Zepbound (tirzepatide for weight management) are not available through CountyCare when prescribed for obesity alone.
There is one narrow exception worth knowing about. A separate CountyCare policy allows Zepbound for the treatment of moderate to severe obstructive sleep apnea, which is a distinct FDA-approved indication. That same policy repeats that Zepbound for weight management “is a benefit exclusion and will not be authorized.”4ILYouthCare (Centene). Clinical Policy: Tirzepatide (Zepbound) for OSA A sleep apnea diagnosis can open a door; wanting to lose weight cannot.
Prior Authorization and Step Therapy
Every GLP-1 prescription through CountyCare requires prior authorization, which is processed by CVS Caremark, the plan’s pharmacy benefits administrator.5CountyCare. Preferred Drug List The prescriber has to document the type 2 diabetes diagnosis and, for most non-preferred drugs, show that a preferred GLP-1 was tried and did not work.
CountyCare defines an “adequate trial” of a preferred GLP-1 as three consecutive months on a stable, therapeutic maintenance dose. Time on a starter dose does not count unless the prescriber documents a clinical reason the member could not tolerate dose escalation.6CountyCare. Optimizing GLP Receptor Agonist Therapy With Trulicity, for example, the 0.75 mg weekly dose is considered an initiation dose, and only the 1.5 mg, 3 mg, or 4.5 mg weekly doses count toward step therapy.
How To Request Authorization, Get an Emergency Supply, or Appeal
Prescribers submit a Medication Request Form to CVS Caremark by fax at 1-866-255-7569 or through an online portal, with clinical documentation supporting medical necessity for the specific drug.5CountyCare. Preferred Drug List
If a member needs medication while an authorization is pending, the pharmacy can call the CVS Caremark Pharmacy Help Desk at 1-800-364-6331 to arrange up to a 72-hour emergency supply. CountyCare’s own pharmacy help desk is open around the clock at 1-833-845-4702, or by email at CountyCarePharmacy@cookcountyhhs.org.5CountyCare. Preferred Drug List
If the request is denied, the member or provider has 30 days from the denial to file an appeal. Appeals require a completed Authorized Representative Form and are mailed to CountyCare Health Plan, P.O. Box 21153, Eagan, MN 55121. Expedited appeals are available for urgent situations. If the internal appeal fails, the member can request a State Fair Hearing or an external independent review.7CountyCare. CountyCare Provider Manual
Why the Weight-Loss Exclusion Exists
The exclusion is not specific to CountyCare. Under the federal Medicaid Drug Rebate Program, states must cover almost all FDA-approved drugs for medically accepted indications, but a statutory carve-out allows them to exclude drugs used for weight loss, cosmetic purposes, hair growth, fertility, and erectile dysfunction.8KFF. Medicaid Coverage of and Spending on GLP-1s Illinois uses that option.
A 2023 Illinois law expanded GLP-1 coverage for weight loss, but only under the state employee health insurance program; it did not extend to the roughly 3.9 million Illinoisans on Medicaid.9Chicago Sun-Times. Weight Loss Drug Coverage Illinois State Workers A later bill, HB3335, was introduced in February 2025 to require Medicaid to cover prescription weight loss drugs with a $200 monthly copay cap. It was re-referred to the House Rules Committee in March 2025 and has not moved since.10LegiScan. Illinois HB3335 Unless that changes, the practical answer for CountyCare members has not changed either: GLP-1 for diabetes, yes; GLP-1 for weight loss, no.