No. Medi-Cal does not cover Ozempic for weight loss. The program pays for Ozempic only for its FDA-approved use: improving blood sugar control in adults with Type 2 diabetes.1Department of Health Care Services. Medi-Cal Rx Contract Drugs List A 2025–26 state budget change went further: effective January 1, 2026, Medi-Cal Rx no longer covers any GLP-1 drug when prescribed for weight loss, with only narrow exceptions.2Medi-Cal Rx. State Budget Updates
What the 2026 Budget Change Did
Starting January 1, 2026, GLP-1 medications prescribed for weight loss are not a Medi-Cal benefit. The exclusion covers an entire drug class: Ozempic, Wegovy, Zepbound, Saxenda, Mounjaro, Trulicity, Victoza, and Rybelsus. Any prior authorizations that had been approved for weight-loss use expired on December 31, 2025, and new requests to continue that therapy are being denied.3Medi-Cal Rx. Important Update: GLP-1s for Weight Loss Are Not a Covered Benefit
Federal Medicaid law has long allowed states to refuse coverage for drugs used for weight loss or weight gain, and California has exercised that option.4Office of the Law Revision Counsel. 42 USC 1396r-8 – Payment for Covered Outpatient Drugs The budget change made that position across-the-board for the GLP-1 class. Comorbidities like high blood pressure do not change the result on their own.
The Narrow Exceptions Still Reviewed
Medi-Cal Rx will still consider prior authorization requests on a case-by-case basis for certain non-weight-loss uses that the FDA has approved:5Medi-Cal Rx. Changes to GLP-1 Drug Coverage
- Wegovy, when prescribed for noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), or to reduce cardiovascular risk in adults with established heart disease who also have obesity or overweight.
- Zepbound, when prescribed for obstructive sleep apnea.
- Members under 21, for whom GLP-1 drugs for weight management may still be reviewed case by case under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.2Medi-Cal Rx. State Budget Updates
Ozempic itself is not on this exception list for non-diabetes uses. If you are an adult and your prescription is for weight loss, there is no pathway at Medi-Cal to get it covered.
When Medi-Cal Will Cover Ozempic
The one route to covered Ozempic is a Type 2 diabetes diagnosis. Ozempic appears on the Medi-Cal Rx Contract Drugs List as a restricted drug, which means your prescriber must submit a prior authorization request before the pharmacy can fill it.1Department of Health Care Services. Medi-Cal Rx Contract Drugs List That request has to show the drug is being used to manage Type 2 diabetes, typically with the diagnosis code, a recent Hemoglobin A1c result, and a record of other diabetes medications already tried.3Medi-Cal Rx. Important Update: GLP-1s for Weight Loss Are Not a Covered Benefit GLP-1 drugs prescribed for Type 2 diabetes were not affected by the 2026 budget change and remain covered through this process.2Medi-Cal Rx. State Budget Updates
Even if your doctor believes losing weight would improve your health overall, Ozempic will not be covered unless the prescription is tied to diabetes management. A desire to lose weight, on its own, is not a basis Medi-Cal will accept.
What Ozempic Costs Without Coverage
Paying out of pocket is expensive. Ozempic’s list price is roughly $1,000 per month in 2026, with actual pharmacy prices varying by dosage. Novo Nordisk has announced a list price reduction to $675 per month effective January 1, 2027, but that change has not yet taken effect.
Medi-Cal members also cannot fall back on the usual manufacturer help. Novo Nordisk’s Patient Assistance Program for Ozempic is open only to uninsured patients with household incomes below 200 percent of the federal poverty level, so Medi-Cal enrollees do not qualify. Federal anti-kickback rules separately prevent people with Medicaid coverage from using manufacturer copay cards or pharmacy discount coupons, because those are treated as improper financial incentives tied to a federally funded health program.4Office of the Law Revision Counsel. 42 USC 1396r-8 – Payment for Covered Outpatient Drugs For a current Medi-Cal member who wants Ozempic for weight loss, there is no subsidized path through the state program or the manufacturer.
If You Were Denied and Think You Shouldn’t Have Been
A denial notice spells out the specific reason the request was rejected and explains how to appeal. If you believe your medical situation was not properly considered, you can request a State Fair Hearing.6DHCS – CA.gov. Medi-Cal Fair Hearing You have 90 days from the date you receive the Notice of Action to file.7California Department of Health Care Services / Medi-Cal Rx. State Fair Hearing Request Form The request form is usually printed on the back of the denial itself. Filing by the effective date on the notice allows existing benefits to continue while the hearing is pending. The hearing is your chance to put additional evidence in front of an independent reviewer, such as updated lab results or documentation that other diabetes medications failed or caused serious side effects. You can also call the Medi-Cal Rx Customer Service Center at 1-800-977-2273 to check on the status of a pending request.8Department of Health Care Services. Medi-Cal Rx Post-Implementation FAQ
If the denial was correct — the prescription is for weight loss and you are an adult outside the narrow exceptions — an appeal will not change the outcome, because the exclusion is a program rule rather than a case-by-case judgment call.