Changes to weight loss drug coverage
starting July 3, 2026
Starting July 3, 2026, Fallon Health’s Medicaid ACO plans will no longer cover medications when used only for weight loss.
This includes drugs used to:
- Suppress appetite
- Treat obesity or being overweight
All previously approved authorizations for medications used for weight loss will end effective 7/2/2026. These medications will no longer be covered starting 7/3/2026.
GLP-1 medications (like Ozempic and Mounjaro) will still be covered if they are being used specifically to treat diagnosed Type 2 diabetes or diagnosed prediabetes. With an approved prior authorization request, coverage of weight loss medications will be limited to Obstructive Sleep Apnea (OSA), Metabolic Dysfunction-Associated Steatohepatitis (MASH), Major Adverse Cardiovascular Events (MACE), or members who qualify who are under 21 years of age.
List of drugs for weight loss that will not be covered as of July 3, 2026*
- ADIPEX-P CAP 37.5MG
- ADIPEX-P TAB 37.5MG
- BENZPHETAMIN TAB 50MG
- CONTRAVE TAB 8-90MG
- DIETHYLPROP TAB 25MG
- DIETHYLPROP TAB 75MG ER
- LOMAIRA TAB 8MG
- ORLISTAT CAPS 120MG
- PHENDIMETRAZ CAP 105MG ER
- PHENDIMETRAZ TAB 35MG
- PHENTERMINE CAP 15MG
- PHENTERMINE CAP 30MG
- PHENTERMINE CAP 37.5MG
- PHENTERMINE TAB 37.5MG
- QSYMIA CAP 11.25-69
- QSYMIA CAP 15-92MG
- QSYMIA CAP 3.75-23
- QSYMIACAP 7.5-46MG
- SAXENDA INJ 18MG/3ML
- WEGOVY INJ 0.25MG
- WEGOVY INJ 0.5MG
- WEGOVY INJ 1.7MG
- WEGOVY INJ 1MG
- WEGOVY INJ 2.4MG
- XENICAL CAP 120MG
- ZEPBOUND INJ 10/0.5ML
- ZEPBOUND INJ 12.5/0.5
- ZEPBOUND INJ 15/0.5ML
- ZEPBOUND INJ 2.5/0.5
- ZEPBOUND INJ 5/0.5ML
- ZEPBOUND INJ 7.5/0.5
Questions?
If you have questions or concerns about this change, please contact us at 1-855-508-3390 (TRS 711), 8 a.m. to 6 p.m., Monday–Friday.
* This list of drugs is subject to change.
