Maryland Medicaid covers GLP-1 medications when they are prescribed for type 2 diabetes, and it covers Wegovy and Zepbound in narrow circumstances tied to cardiovascular disease, advanced fatty liver disease, or moderate-to-severe sleep apnea. It does not cover any GLP-1 drug prescribed for weight loss alone. A law signed in May 2026 could change that as early as January 1, 2027, but only if the Maryland Department of Health chooses to act on the authority the law gives it.
GLP-1 Drugs Covered for Type 2 Diabetes
If you have type 2 diabetes, the Maryland Medical Assistance Program covers Ozempic, Trulicity, Victoza (liraglutide), Byetta (exenatide), Bydureon, Mounjaro, and Rybelsus.1Maryland.gov. Maryland Medical Assistance Program – Obesity Treatment Coverage Report Every one of these drugs requires prior authorization and is subject to quantity limits.2Wellpoint. Maryland Medicaid Preferred Drug List Approval usually depends on a confirmed diabetes diagnosis, documented A1c levels, and ongoing clinical monitoring.3MedStar Family Choice. Prior Authorization Criteria for GLP-1 Medications
On the Preferred Drug List effective January 2026, exenatide (Byetta) and liraglutide (Victoza) are the preferred options. Ozempic, Trulicity, Mounjaro, and Rybelsus sit in a more restricted tier that still requires prior authorization.4Maryland.gov. Maryland Medicaid Preferred Drug List – January 1, 2026 A prescriber who wants a non-preferred drug typically has to justify why the preferred one won’t work.
When Wegovy and Zepbound Are Covered
Wegovy and Zepbound are the two GLP-1 drugs the FDA has approved specifically for weight management, and Maryland Medicaid covers them only when a patient has a serious additional condition.
Wegovy is covered for patients with established cardiovascular disease, meaning a history of heart attack, stroke, or symptomatic peripheral arterial disease, along with a BMI of 27 or higher. A cardiologist must be involved in prescribing. This cardiovascular coverage took effect in September 2024 after the FDA approved Wegovy for reducing the risk of cardiovascular death, heart attack, and stroke.1Maryland.gov. Maryland Medical Assistance Program – Obesity Treatment Coverage Report Wegovy is also covered for adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (a form of advanced fatty liver disease) and moderate to advanced fibrosis, when a gastroenterologist or hepatologist prescribes it.5Maryland.gov. Wegovy or Zepbound Prior Authorization Form
Zepbound is covered only for adults with moderate to severe obstructive sleep apnea confirmed by a sleep study showing an apnea-hypopnea index of 15 or more events per hour. The patient needs a BMI of 30 or higher, and a sleep specialist or pulmonologist must be involved.
For both Wegovy and Zepbound, patients also have to show that a weight loss management program was tried in the prior six months without success, and the medication has to be used alongside a reduced-calorie diet and exercise plan.5Maryland.gov. Wegovy or Zepbound Prior Authorization Form
Weight Loss Alone Is Not a Covered Reason
If a provider submits a prior authorization request for any GLP-1 medication and lists weight loss as the reason, the request will be denied. Maryland’s managed care organizations have stated that requests for weight management indications “cannot be approved.”6MedStar Family Choice. Statement on Weight Loss Medication A high BMI on its own, without diabetes, cardiovascular disease, qualifying liver disease, or qualifying sleep apnea, is not enough.
The reason is federal law. Under the Medicaid Drug Rebate Program, states have to cover nearly all FDA-approved drugs, but a specific exception lets them exclude “agents when used for … weight loss.” Coverage for the same drugs when used to treat diabetes, cardiovascular disease, or sleep apnea stays in place because those are separate FDA-approved indications that fall outside the weight-loss exclusion. As of January 2026, only 13 state Medicaid programs covered GLP-1s for obesity, and several that had previously offered the benefit, including California, New Hampshire, Pennsylvania, and South Carolina, had dropped it under budget pressure.7KFF. Medicaid Coverage of and Spending on GLP-1s
What Could Change in 2027
Senate Bill 496, signed into law on May 31, 2026, as Chapter 866, authorizes the Maryland Medical Assistance Program to provide comprehensive coverage for obesity treatment starting January 1, 2027. If implemented, that coverage could include intensive behavioral therapy, bariatric surgery, and any FDA-approved medication for chronic weight management.8LegiScan. Maryland SB 4969Maryland General Assembly. Fiscal and Policy Note for SB 496
The word “authorizes” is doing a lot of work here. The law does not require the Department of Health to add this benefit. It gives the department the legal authority to do so and lets it apply to CMS for the state plan amendment that would be needed. If the department moves forward, it has to notify Medicaid recipients and report back to the General Assembly by November 1, 2027, on the status of the new benefit.9Maryland General Assembly. Fiscal and Policy Note for SB 496
Cost is the central reason the decision is not automatic. Maryland Medicaid already spends roughly $122 million per year on GLP-1s for currently covered indications, and the state’s fiscal note projected that adding obesity coverage could cost up to $449.4 million annually at a 25% uptake rate.1Maryland.gov. Maryland Medical Assistance Program – Obesity Treatment Coverage Report9Maryland General Assembly. Fiscal and Policy Note for SB 496 The bill’s lead sponsor, Senator Steve Hershey, has called those projections “wildly inflated,” arguing that actual uptake in other states has been closer to 3%.10CBS News Baltimore. Maryland Ozempic Medicaid Weight Loss Cost Senate
Pricing could also shift through a federal program called the BALANCE Model, which CMS announced in December 2025 to negotiate lower GLP-1 prices for participating state Medicaid agencies. Novo Nordisk and Eli Lilly are both participating, and the covered drugs include Mounjaro, Ozempic, Rybelsus, Wegovy, and the KwikPen formulation of Zepbound.11CMS. BALANCE Model12KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid As of March 2026, Maryland’s Department of Health was still evaluating the model and had not applied, citing a lack of pricing and access details.9Maryland General Assembly. Fiscal and Policy Note for SB 496
Until the Department of Health acts, the coverage picture for Maryland Medicaid enrollees stays what it is today: GLP-1s are available for diabetes with prior authorization, Wegovy and Zepbound are available for the specific qualifying conditions described above, and prescriptions written solely for weight loss will be denied.