Whether Medicaid covers Contrave depends entirely on the state you live in. Some state Medicaid programs pay for the brand-name naltrexone-bupropion weight-loss pill, usually with strict prior authorization. Others exclude it along with every other anti-obesity medication. Federal law lets each state decide, so there is no single national answer, and no federal program currently expands Contrave access the way one does for certain GLP-1 drugs.
Why Coverage Depends on Your State
Section 1927(d)(2) of the Social Security Act lets state Medicaid programs exclude drugs used for “anorexia, weight loss, or weight gain” from their formularies.1KFF. Medicaid Coverage of and Spending on GLP-1s Weight-loss medications sit outside the usual Medicaid rule that requires coverage of nearly all FDA-approved drugs. Each state writes its own policy on whether Contrave is on the formulary at all, and under what rules.
The Biden administration proposed a rule in November 2024 that would have effectively required state Medicaid programs to cover anti-obesity drugs for people diagnosed with obesity.2KFF. Proposed Coverage of Anti-Obesity Drugs in Medicare and Medicaid Would Expand Access to Millions of People With Obesity CMS dropped that provision from the final rule issued April 4, 2025.3Applied Policy. CMS Finalizes CY 2026 Changes to Medicare Advantage and Part D Without Key Provisions Related to Access to Anti-Obesity Medications and Health Equity The old exclusion still stands.
The STOP Obesity Alliance at George Washington University tracks which states cover newer-generation obesity drugs like Wegovy, which cover older-generation medications (the category that includes Contrave, Qsymia, and phentermine), and which cover none.4STOP Obesity Alliance. Medicaid Coverage 2024 That tracker is the quickest way to see where your state stands. Call your Medicaid plan directly to confirm, because formularies change. State coverage has been shrinking under budget pressure: only 13 state Medicaid programs covered GLP-1 drugs for obesity under fee-for-service as of January 2026, down from 16 three months earlier, with California, New Hampshire, Pennsylvania, and South Carolina dropping coverage.1KFF. Medicaid Coverage of and Spending on GLP-1s
There is a small silver lining in that trend for Contrave. Some states that restrict GLP-1 access require patients to try older, cheaper medications first. Michigan’s new rules effective January 2026, for example, limit GLP-1 coverage to patients with a BMI of 40 or higher and require documented failure of other weight-loss drugs including phentermine and Qsymia.5University of Michigan. Expert Q&A on Michigan Medicaid’s New Limits on GLP-1 Weight Management Medications That kind of step-therapy design can create a path to older medications like Contrave even in restrictive states.
What Approval Usually Requires
When a state Medicaid program does cover Contrave, it almost always requires prior authorization. Your prescriber has to submit clinical documentation before the plan will pay.6GoodRx. Here’s How to Save on Weight Loss Medication Contrave Criteria vary, but the common ones are:
- A BMI of at least 30, or at least 27 with a qualifying condition such as type 2 diabetes, hypertension, high cholesterol, or obstructive sleep apnea.7PacificSource. Contrave Prior Authorization Criteria
- Documented diet and exercise effort before approval. Delaware, for example, requires at least three months of documented nutritional therapy, exercise, and behavior modification.8Delaware DMAP. Anti-Obesity Medication Prior Authorization Criteria
- Step therapy. Some plans require you to try and fail less expensive medications first.
- Proof of progress for renewal. Delaware requires at least a 5% reduction from baseline body weight to reauthorize, and denies continued coverage for at least a year if more than half the lost weight is regained.8Delaware DMAP. Anti-Obesity Medication Prior Authorization Criteria
Contrave itself is FDA-approved for adults with a BMI of 30 or higher, or 27 or higher with at least one weight-related condition, as an addition to a reduced-calorie diet and increased physical activity.9FDA. Contrave Prescribing Information If you don’t meet the clinical criteria the label sets out, most Medicaid plans won’t approve it even in states that cover the drug.
If Your Plan Denies It
You can request a formulary exception. Your prescriber submits a formal request explaining why covered alternatives aren’t appropriate for you. The plan has to respond within 72 hours for a standard request, or 24 hours when a delay could cause serious harm.10Patient Advocate Foundation. Filing a Formulary Exception A denial at that stage can be appealed further.
What Contrave Costs Without Medicaid Coverage
Retail price for a 30-day supply of 120 tablets runs roughly $530 to $757, depending on pharmacy.11GoodRx. Here’s How to Save on Weight Loss Medication Contrave A few routes can bring that down.
The manufacturer’s copay savings card does not work for Medicaid or Medicare beneficiaries. The terms explicitly exclude anyone with government insurance.12Contrave. Savings Offers Terms and Conditions13Contrave. Contrave Savings14GoodRx. Here’s How to Save on Weight Loss Medication Contrave
Discount platforms like GoodRx list Contrave around $199 for 120 tablets at participating pharmacies, open to anyone regardless of insurance status.15GoodRx. Contrave Prices and Coupons You can’t stack these cards with insurance at the counter, but you can use them as a cash alternative.
Prescribing the Two Ingredients Separately
Contrave combines bupropion and naltrexone in one extended-release tablet. There is no FDA-approved generic for the combination product, and patents on it run through at least 2030, with some claims reaching 2034.16Drugs.com. Generic Availability of Contrave But both active ingredients are cheap generics on their own. Some clinicians prescribe bupropion SR and naltrexone as two separate medications to approximate the therapy at a fraction of the price. Dartmouth-Hitchcock Medical Center publishes titration schedules for this approach and notes that “the 2 generic medications that make up Contrave can be prescribed separately to save money.”17Dartmouth-Hitchcock. PEAC Before and After Example
For Medicaid patients, this matters. Bupropion is routinely covered for depression and naltrexone for alcohol or opioid dependence, so the generics may be accessible through your plan even when the branded combination isn’t. Off-label use for weight loss may still require your prescriber to document the indication, and the two-pill dosing schedule is not the same as splitting a Contrave tablet. Ask your prescriber about this option rather than trying to improvise it.
Medicare and the BALANCE Model Won’t Help
If you’re asking about Contrave because you’re on Medicare rather than Medicaid, the answer is harder. Medicare Part D has its own statutory exclusion for weight-loss drugs, and currently has no pathway to cover Contrave for weight loss at all.18Medicare Interactive. Drugs Excluded From Part D Coverage The Treat and Reduce Obesity Act, legislation that would remove the exclusion from both Medicare and Medicaid, has been reintroduced several times since 2013 but has not passed.19PMC. The Treat and Reduce Obesity Act
The Trump administration’s BALANCE model, announced in December 2025, uses federal negotiating power to lower obesity drug prices for state Medicaid programs starting May 2026 and for Medicare Part D in January 2027. Contrave is not part of it. The program is limited to GLP-1 and GIP receptor agonists (Mounjaro, Ozempic, Rybelsus, Wegovy, Zepbound KwikPen, and orforglipron if approved) that have shown at least 9.5% body weight reduction in clinical trials, a threshold Contrave doesn’t meet.20CMS. BALANCE Model21KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid For the foreseeable future, Contrave access through Medicaid will be decided one state formulary at a time.