Medi-Cal does not cover Wegovy for weight loss. As of January 1, 2026, California’s Medicaid program removed Wegovy and the other weight-management GLP-1 drugs (Zepbound and Saxenda) from the Medi-Cal Rx Contract Drugs List for members 21 and older, and the state has stated plainly that weight loss is not a covered indication.1Medi-Cal Rx. Changes to GLP-1 Drug Coverage – Wegovy Wegovy can still be covered when prescribed for two specific medical conditions, and members under 21 have a separate path.
What Changed on January 1, 2026
Claims submitted to Medi-Cal for Wegovy prescribed for weight loss now deny with “Reject Code 70 – Product/Service Not Covered.”2Medi-Cal Rx. Changes to Medi-Cal Rx Effective January 2026 The rule applies the same way in both fee-for-service Medi-Cal and managed care plans across the state.3California Medical Association. GLP-1 Medications for Weight Loss Will No Longer Be Covered by Medi-Cal
There is no grandfathering. If you were already filling Wegovy under Medi-Cal before the cutoff, your prior authorization expired on December 31, 2025. The state’s policy says explicitly that already being on the drug “does not suffice as justification for approval.” Other GLP-1 medications such as Ozempic and Mounjaro remain on the Contract Drugs List, but only for type 2 diabetes. None of them can be prescribed through Medi-Cal for weight loss.2Medi-Cal Rx. Changes to Medi-Cal Rx Effective January 2026
When Medi-Cal Will Still Pay for Wegovy
Two medical diagnoses can get Wegovy covered. The rules differ.
Noncirrhotic MASH — No Prior Authorization Needed
Starting April 1, 2026, Medi-Cal added Wegovy back to the Contract Drugs List for treating noncirrhotic metabolic dysfunction-associated steatohepatitis, a serious liver disease. If your prescriber submits the claim with ICD-10 code K76.0 and/or K75.8, it processes without a prior authorization.1Medi-Cal Rx. Changes to GLP-1 Drug Coverage – Wegovy The FDA granted Wegovy accelerated approval for MASH in August 2025.4FDA. FDA Approves Treatment for Serious Liver Disease Known as MASH
Cardiovascular Disease — Prior Authorization Required
Wegovy may also be covered to reduce cardiovascular risk, but every request is reviewed case by case for medical necessity.5Medi-Cal Rx. State Budget Policy Updates FAQ There is no automatic approval, and the state has not published a specific list of qualifying diagnosis codes; providers are told to consult the Medi-Cal Rx Diagnosis Crosswalk or contact the Medi-Cal Rx Customer Service Center.6Medi-Cal Rx. GLP-1 Coverage Considerations
The underlying FDA approval, issued in March 2024, is for reducing the risk of heart attack, stroke, or cardiovascular death in adults with established heart disease who also have obesity or overweight.7FDA. Wegovy Prescribing Information Practically, your prescriber will need to document the cardiovascular condition and show that the prescription is for that condition rather than for weight loss.
If You’re Under 21
Federal Medicaid law requires a broader set of treatments for children and young adults through the Early and Periodic Screening, Diagnostic, and Treatment benefit (EPSDT). Under EPSDT, Medi-Cal will review prior authorization requests for GLP-1 weight-loss medications for members younger than 21 based on medical necessity.8Medi-Cal Rx. GLP-1 Changes Member Information Approval is not automatic, but requests are considered.
If Your Claim Is Denied
You can request a State Hearing from the California Department of Social Services within 90 days of a denial. There is also a short “aid paid pending” window for members who were already taking one of the affected drugs on or before January 1, 2026: if you file your hearing request within 10 days of the denial notice, you may keep receiving the medication until the hearing is decided, the prior authorization period ends, or the case closes, whichever comes first.8Medi-Cal Rx. GLP-1 Changes Member Information
What Medi-Cal Still Covers for Weight Loss
For adult members, the main covered treatment for significant obesity is bariatric surgery. Medi-Cal covers procedures such as gastric sleeve and gastric bypass for patients with a BMI of 40 or higher, or a BMI of 35 or higher with at least one serious obesity-related condition such as type 2 diabetes or hypertension. Qualifying also requires documented prior attempts at medically supervised weight loss, a full medical evaluation, and a psychological assessment.9West Medical. Understanding Medi-Cal Requirements for Bariatric Surgery in California
Is This Likely to Change?
Not from the federal side in the near term. A proposed Biden-era rule (CMS-4208-P) would have required state Medicaid programs to cover anti-obesity medications, but CMS confirmed in its Contract Year 2026 final rule that the provision was excluded, while reserving the right to revisit it later.10CMS. Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program – Final Rule As of January 2026, only 13 state Medicaid programs covered GLP-1s for weight loss, and California is no longer among them.11KFF. Medicaid Coverage of and Spending on GLP-1s
At the state level, California Senate Bill 1089, introduced in 2026, would require CalPERS to cover GLP-1 medications for chronic weight management in at least one health plan beginning January 2027. SB 1089 applies to state employee coverage, not Medi-Cal.12CHBRP. SB 1089 Preventive Treatment Care Act Analysis No pending legislation would restore Medi-Cal coverage of Wegovy for weight loss.