Medi-Cal covers Ozempic for type 2 diabetes, and has not covered it for weight loss since January 1, 2026. Medi-Cal Rx, the program’s pharmacy benefit, lists Ozempic among seven GLP-1 drugs that stay on its Contract Drugs List with a type 2 diabetes diagnosis restriction[2]. The same notice says that from January 1, 2026 these drugs are no longer eligible for coverage for weight loss or weight loss-related indications[2].
The change reaches every GLP-1 brand. Wegovy and Zepbound, the semaglutide and tirzepatide brands approved for weight management, lost coverage for weight loss on the same date.[2] Medi-Cal Rx ties the change to the enacted 2025-26 California State Budget[1]. What a prescription costs without that coverage is in Ozempic cost.
| Drug | Weight loss only | Other uses |
|---|---|---|
| Ozempic, Rybelsus, Mounjaro | Not covered | Covered for type 2 diabetes when the diagnosis code is on the claim |
| Victoza, Byetta, Bydureon, Trulicity | Not covered | Covered for type 2 diabetes when the diagnosis code is on the claim |
| Wegovy | Not covered | Covered for noncirrhotic MASH with the diagnosis code; a PA request for cardiovascular disease |
| Zepbound | Not covered | Off the Contract Drugs List; a PA request for obstructive sleep apnea |
| Saxenda | Not covered | Off the Contract Drugs List |
Ozempic for diabetes: what the claim needs
The Contract Drugs List, dated September 1, 2026, restricts Ozempic to use in improving glycemic control in patients with type 2 diabetes mellitus[5]. Mounjaro carries the same restriction, plus a limit of one carton of four pens per fill and one fill every 28 days[5].
In practice the restriction is checked at the pharmacy counter. Claims for the seven diabetes drugs deny with Reject Code 80 when the diagnosis restriction is not met[2]. The member notice puts it plainly: if you take one of these drugs for type 2 diabetes, it will continue to be covered if your prescriber submits a diagnosis code with your prescription[4].
Weight loss: what ended, and when
Medi-Cal Rx announced the change to prescribers in an October 21, 2025 bulletin[1]. Claims for Saxenda, Wegovy and Zepbound with a date of service on or after January 1, 2026 deny with Reject Code 70, Product/Service Not Covered[1]. The message the pharmacy sees reads: “GLP-1s for weight loss are not covered.”[1]
Approvals already in place did not carry over. All previously approved prior authorizations for these drugs expired on December 31, 2025[2]. The members’ FAQ confirms that a drug taken for weight loss is not covered even if you already had an approved PA[3].
Zepbound and Saxenda were removed from the Contract Drugs List entirely on January 1, 2026[2]. Wegovy stays on the list, but only for noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)[5].
The uses Medi-Cal still covers
The October bulletin says Medi-Cal Rx will continue to cover GLP-1 drugs for FDA-approved uses such as type 2 diabetes, atherosclerotic cardiovascular disease and chronic kidney disease[1]. That coverage depends on a diagnosis code, utilization controls and medical necessity[1].
For Wegovy, from April 1, 2026, a MASH prescription needs no prior authorization when the claim carries ICD-10 code K76.0 and/or K75.8[2]. A request for another use, such as cardiovascular disease, is reviewed on medical necessity[2]. For Zepbound, Medi-Cal Rx will consider a prior authorization request when it is used for obstructive sleep apnea[2]. How Zepbound’s sleep apnea approval plays out in other plans is covered in is Zepbound covered by insurance.
Why a state can drop weight-loss coverage
Federal Medicaid law lets each state exclude or restrict certain drug uses. The list opens with “agents when used for anorexia, weight loss, or weight gain”[7]. California used that option in its 2025-26 budget[1]. How the same rule plays out across other states is in does Medicaid cover Ozempic.
The federal BALANCE model could change the answer in some states. Under it, CMS negotiates GLP-1 prices and coverage terms with drug makers on behalf of state Medicaid agencies, which can join from May 2026 through January 1, 2027[6]. CMS says coverage in Medicaid will depend on participation by drug manufacturers and states, and that the model will not guarantee coverage for any individual[6]. Whether California takes part is a state decision: the Medi-Cal Rx bulletins page and the CMS BALANCE page are where a change would appear.
If Medi-Cal denies your GLP-1
A member who gets a Notice of Action denying a GLP-1 has the right to a State Hearing, generally requested within 90 days of the notice from the California Department of Social Services[3]. To keep a drug you are already taking while the hearing is pending, you generally need to ask within 10 days of receiving the notice and say you want aid to continue[3]. That continued coverage lasts only until the current PA period ends, a decision is issued, or the hearing is withdrawn or closed, whichever comes first[3].
The FAQ describes that right for any GLP-1 denial. For a prescription written for weight loss only, the same FAQ states the drug is no longer a covered benefit as of January 1, 2026[3].
Paying yourself
The FAQ says you can pay out of pocket for a GLP-1 at the pharmacy, and that some discount cards work for Medi-Cal members[3]. Medi-Cal Rx will not pay you back for a GLP-1 bought for weight loss, since it is no longer a covered benefit[3]. What each brand costs without insurance is in GLP-1 cost without insurance, and compounded versions are compared on the price boards. A compounded drug is a different product from the brand.