No. Peach State Health Plan does not cover medications prescribed for weight loss under its Georgia Medicaid pharmacy benefit. The Preferred Drug List carries an explicit exclusion for “drugs prescribed for weight loss,” which keeps popular obesity medications off the formulary regardless of prior authorization.1Peach State Health Plan. Preferred Drug List
Which Drugs Are Excluded
Wegovy (semaglutide), Zepbound (tirzepatide), Contrave, Saxenda, and Qsymia do not appear as covered drugs on the Peach State Medicaid formulary. Plenity, a non-drug weight management device, is listed in the anorexiants category as “Non-Preferred,” but it still falls under the plan’s blanket exclusion for weight loss products.1Peach State Health Plan. Preferred Drug List
Because these drugs are categorically excluded, they also do not qualify for Peach State’s 72-hour emergency supply policy that applies to certain other medications while prior authorization is pending.
The Diabetes Exception
The same GLP-1 molecules that are excluded for obesity can be covered when prescribed for a different FDA-approved condition. Georgia Medicaid does not cover GLP-1 medications for weight loss, but they may be covered when prescribed for diabetes or cardiovascular risk management.2QuickMD. Weight Loss in Georgia The Georgia Medicaid fee-for-service Preferred Drug List includes Ozempic (semaglutide) and Victoza (liraglutide) in the “Incretin Mimetic Agents (GLP-1 Receptor Agonists)” category, with all listed drugs requiring prior authorization.3Georgia Medicaid. Georgia Preferred Drug List
This matters because semaglutide is sold as Ozempic for type 2 diabetes and as Wegovy for weight management. A Peach State member with a type 2 diabetes diagnosis may be able to get Ozempic approved through prior authorization. The same member cannot get Wegovy if the prescription is written solely for obesity.
Can You Appeal or Get a Medical Necessity Override?
Peach State has a general process for requesting non-formulary drugs. A provider can submit a medical necessity request documenting that the member tried at least two PDL drugs in the same therapeutic class, is allergic to or intolerant of those alternatives, or cannot use any formulary option for the diagnosis.4Peach State Health Plan. Preferred Drug List Requests go through the Cover My Meds portal, and reviews are usually completed within 24 hours.5Peach State Health Plan. Pharmacy Provider Page
That process rarely helps for weight loss drugs. The exclusion applies to the entire category rather than to specific products, so a standard override is unlikely to produce coverage when the only indication is obesity. Federal law permits states to cover excluded weight loss drugs for documented medical necessity, but Georgia has not taken that step.6Brevy. Georgia Prescription Drug Coverage and PDL
If a request is denied, you have the right to file a formal appeal within 60 calendar days of the denial notice. Appeals can be filed by phone at 1-800-704-1484 or in writing to the Peach State Grievance and Appeals Coordinator. The plan must acknowledge the appeal within 10 days and decide it within 30 days. Expedited appeals, available when a delay could seriously harm your health, are decided within 72 hours. If the appeal is unsuccessful, you can request a State Fair Hearing within 120 days of the appeal decision.7Peach State Health Plan. Filing an Appeal
Ambetter Is a Separate Plan
If your coverage is through Ambetter from Peach State, the Affordable Care Act marketplace plan, the rules are different from Medicaid. The 2025 Ambetter formulary listed Contrave at Tier 3 with prior authorization and a quantity limit, along with phendimetrazine and phentermine at Tier 1B with prior authorization.8Ambetter Health. 2025 Georgia Formulary The 2026 Ambetter formulary appears narrower: it keeps phendimetrazine and phentermine with prior authorization, drops Contrave, and does not include Wegovy or Zepbound.9Ambetter Health. 2026 Georgia Formulary Check your specific benefit documents, because the formulary notes that individual plan designs may not cover certain products or categories.
Why the Exclusion Exists
The exclusion is not Peach State’s own policy choice. Under the Medicaid Drug Rebate Program (42 U.S.C. ยง 1396r-8), states must generally cover most outpatient prescription drugs, but a specific exception lets them exclude drugs used for weight loss, anorexia, or weight gain.10CMS. Contract Year 2026 Policy and Technical Changes Final Rule Georgia uses that exception, and all three of its Medicaid managed care organizations, including Peach State, Amerigroup, and WellCare/CareSource, administer the pharmacy benefit on the same terms.11Scale Solutions. GLP-1 Cost and Insurance Georgia Switching to a different Georgia Medicaid plan will not get you weight loss drug coverage.
Your most realistic path within Peach State is to work with your provider on whether a qualifying secondary diagnosis, such as type 2 diabetes, supports prior authorization for a GLP-1 approved for that condition. If you believe your situation warrants an exception for obesity alone, you can still submit a prior authorization request and use the appeal and State Fair Hearing process if it is denied.