SACRAMENTO, CA — Starting January 1, 2026, California will end Medi-Cal coverage for popular weight-loss drugs such as Wegovy, Zepbound and Saxenda when prescribed solely for obesity or weight loss, state health officials announced, citing soaring pharmaceutical costs, budget pressures and Medicaid spending cuts. The decision comes despite recent federal efforts to negotiate price reductions on these medications.
Under changes to Medi-Cal Rx, California’s Medicaid pharmacy benefit program, prior authorizations for GLP-1 drugs used only for weight loss will be discontinued as of Jan. 1, 2026 and pharmacy claims will be denied if submitted for weight-loss indications after that date. Drugs affected include Wegovy, Zepbound, Saxenda and other GLP-1 medications when prescribed for obesity.
State officials said Medi-Cal members and their healthcare providers should consider other “treatment options that can support weight loss, such as diet changes, increased activity or exercise, and counseling.” Critics and some medical experts say those recommendations are unlikely to substitute for the effectiveness of GLP-1 drugs for many patients. One patient cited in reporting said she saw a dramatic change in weight and health with medication that diet and exercise alone had failed to achieve.
The change takes effect even though the Trump administration announced negotiated price cuts for some of the most widely used weight-loss medications through its TrumpRx plan, aimed at lowering costs for consumers and Medicaid programs. Under that plan, the price of Wegovy is expected to fall significantly, but state officials have no plans to reverse the Medi-Cal decision.
California is not alone. Other states like New Hampshire are also dropping or restricting Medicaid coverage for weight-loss indications of GLP-1 drugs as they grapple with budget shortfalls and growing prescription expenses. Analysts say the trend of retreating coverage reflects rising costs and fiscal constraints for state Medicaid programs.
Medicaid will continue to cover GLP-1 medications for other FDA-approved clinical indications, such as type 2 diabetes, cardiovascular disease and chronic kidney disease, if medical necessity is established. Members may also seek hearings if denied coverage and will still be able to pay out of pocket or pursue alternative assistance programs.
Healthcare providers warn that many patients who stop GLP-1 therapy may regain weight and lose associated health benefits, and the policy shift may widen health disparities for low-income residents who previously relied on these medications.
