South Carolina Medicaid weight loss medication coverage ended on January 1, 2026, for drugs prescribed to treat obesity. The South Carolina Department of Health and Human Services removed Wegovy and Saxenda from its Preferred Drug List on that date, reversing a benefit that had been in place for just over a year.1Select Health of SC. Prescription Benefits The state still pays for GLP-1 medications when they are prescribed for other FDA-approved conditions, and it still covers nutritional counseling and bariatric surgery for members who qualify.
What SC Medicaid No Longer Pays For
Prescriptions written for obesity or weight loss alone are no longer covered. That includes Wegovy and Saxenda, the two GLP-1 drugs the state had added to its formulary for weight management in November 2024.2SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity SCDHHS pointed to budget pressures, concerns about federal funding cuts, and an uncertain economic outlook, and noted that the Trump administration had rejected a Biden-era proposal that would have required state Medicaid programs to cover anti-obesity drugs. Without a federal mandate, states can decide for themselves, and South Carolina decided to stop.
Whether older, non-GLP-1 weight loss medications such as phentermine, orlistat, Contrave, or Qsymia remain on the formulary is not clearly spelled out in public materials. The reporting on the change describes it broadly as ending coverage for “weight loss drugs for obesity” without specifying what happens to the older options.2SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity If you take one of these, check the current Preferred Drug List or call your managed care plan to confirm.
GLP-1 Drugs Are Still Covered for Diabetes and Other Conditions
The coverage change applies only to the obesity indication. Under the federal Medicaid Drug Rebate Program, South Carolina must still cover nearly all FDA-approved drugs for their medically accepted uses. In practice, that means SC Medicaid continues to pay for:
- Ozempic and Mounjaro when prescribed for type 2 diabetes
- Wegovy when prescribed to reduce cardiovascular risk
- Zepbound when prescribed for moderate to severe obstructive sleep apnea in adults with obesity
These are separate FDA-approved indications and fall outside the statutory weight-loss exclusion.3KFF. Medicaid Coverage of and Spending on GLP-1s Your prescriber will need to document the covered diagnosis, and the drug may still require prior authorization through your plan.
Obesity Benefits That Remain
Nutritional Counseling
SC Medicaid continues to cover nutritional counseling for adults diagnosed with obesity. Full-benefit members can receive up to 12 hours of combined initial assessment, reassessment, and group medical nutrition therapy per state fiscal year. Sessions can happen in person or by telehealth, in hospitals, health departments, federally qualified health centers, and physician offices. Physicians, physician assistants, nurse practitioners, and registered dietitians can provide the service; dietitian services need a physician referral.4SCDHHS. Nutritional Counseling Services Benefits Update
Bariatric Surgery
Bariatric surgery, including sleeve gastrectomy, remains covered for members who meet medical necessity criteria. Prior authorization is required, and eligibility is determined using InterQual clinical criteria. Fee-for-service members submit requests through the state’s review portal; managed care members submit through their specific plan.5SCDHHS. Coverage for Bariatric Surgery
Members Under 21
Children and young adults on Medicaid have broader obesity benefits than adults. Members under 21 with a BMI at or above the 95th percentile can receive individual and group nutritional counseling, unlimited medically necessary evaluation and management visits to discuss weight loss goals and exercise plans, and additional sessions if the patient remains compliant after an initial course of treatment.6SCDHHS. Children’s NCP Policy Language
Does Your Managed Care Plan Make a Difference?
No. All South Carolina Medicaid managed care organizations follow the single statewide Preferred Drug List maintained by SCDHHS.7Absolute Total Care. Pharmacy The removal of Wegovy and Saxenda for obesity applies the same way across Select Health (First Choice), Absolute Total Care, Molina, and the rest. No plan-level exceptions have been publicly reported.
If you believe a GLP-1 drug is medically necessary for a condition that is still covered, your provider can request prior authorization through your plan. Select Health members can reach Member Services at 1-888-276-2020; other plans list their numbers on the member ID card.
Could the Benefit Come Back?
SCDHHS has not ruled it out. Agency spokesman Jeff Leieritz said the state may reconsider if prices drop enough to make the drugs more affordable. Novo Nordisk has already cut Wegovy’s list price from $1,350 to $349 per month, and under a deal with the Trump administration, the net price for Medicare and Medicaid programs fell to $245 per month.8Reuters. Novo Nordisk Rolls Out $349 Wegovy Cash Price Ahead of Plan
A federal program could also open a path back. The CMS Innovation Center launched the BALANCE model in late 2025, a voluntary five-year program that negotiates lower GLP-1 prices for participating state Medicaid programs and Medicare Part D sponsors. States can begin participating as of May 2026, with applications accepted through July 2026. Participating states must use standardized coverage criteria and cannot impose requirements more restrictive than the model allows.9KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid South Carolina has not publicly said whether it plans to apply.