Medi-Cal (California’s Medicaid program, often called “Medical”) is ending coverage for weight loss medications starting January 1, 2026. Due to the 2025-26 state budget, Medi-Cal Rx will no longer pay for GLP-1 drugs when prescribed specifically for weight loss. This applies to all Medi-Cal members regardless of which plan they’re on. If you’re currently taking one of these medications or considering starting one, here’s what the change means for you.
What’s Changing on January 1, 2026
Medi-Cal Rx currently covers several GLP-1 medications for chronic weight management, including Wegovy, Zepbound, and Saxenda. Starting January 1, 2026, all three will be removed from the approved drug list for weight loss purposes. Any existing prior authorizations for these drugs will expire on that date, even if they were previously approved for months into the future.
The full list of GLP-1 drugs that will no longer be covered for weight loss includes:
- Wegovy (semaglutide)
- Zepbound (tirzepatide)
- Saxenda (liraglutide)
- Ozempic (semaglutide)
- Mounjaro (tirzepatide)
- Rybelsus (semaglutide)
- Victoza (liraglutide)
- Trulicity (dulaglutide)
- Byetta (exenatide)
- Bydureon (exenatide extended-release)
If you start a GLP-1 drug for weight loss between now and January 2026, be aware that your coverage will likely end on that date. Medi-Cal Rx will deny most prior authorization requests for weight loss use going forward.
What’s Still Covered
The same drugs remain covered when prescribed for conditions other than weight loss. Ozempic, Rybelsus, Mounjaro, Victoza, Byetta, Bydureon, and Trulicity all keep their coverage for type 2 diabetes. Your provider will need to submit a diagnosis code for diabetes, and claims will be rejected if that diagnosis isn’t included.
Two of the weight-loss-specific drugs can also still be covered for narrow, non-weight-loss reasons. Wegovy may be approved for cardiovascular disease or a liver condition called noncirrhotic MASH (a severe form of fatty liver disease). Zepbound may be approved for obstructive sleep apnea. In both cases, your provider would need to submit a prior authorization request tied to one of those specific diagnoses, not weight loss.
Exception for Members Under 21
Federal law requires Medicaid programs to cover medically necessary treatments for children and young adults under 21 through a benefit called EPSDT. Because of this, Medi-Cal members younger than 21 can still have prior authorization requests for weight loss medications reviewed on a case-by-case basis after January 2026. Approval isn’t guaranteed, but the door isn’t completely shut for this age group the way it is for adults.
How Prior Authorization Works
Even for the medications that remain covered, you can’t simply fill a prescription at the pharmacy. Your doctor needs to submit a prior authorization request, which is essentially a formal request to Medi-Cal proving the drug is medically necessary for your specific situation.
The process requires your provider to fill out DHCS Form 6560, which asks for your height, weight, allergies, diagnosis codes, and details about any other treatments you’ve already tried. Your doctor also needs to attach supporting documentation like chart notes and lab results. If the request is for an off-label use, peer-reviewed medical journal articles supporting that use must be included. The form can be faxed, mailed, or submitted electronically through CoverMyMeds.
Many insurance programs, including Medi-Cal, use what’s called step therapy. This means you may need to show that less expensive weight management approaches haven’t worked before being approved for a costlier medication. Depending on your weight and health conditions, you might be approved right away, or your insurer may want evidence that you’ve tried other options first.
What This Means If You’re Currently on a GLP-1
If you’re taking Wegovy, Zepbound, or Saxenda for weight loss right now through Medi-Cal, your coverage will end on January 1, 2026. Your prior authorization won’t carry over. Stopping GLP-1 medications abruptly can lead to weight regain, so this is worth discussing with your provider well before the cutoff date. They can help you plan a transition, whether that means tapering off the medication, exploring whether you qualify for coverage under a non-weight-loss diagnosis, or looking into other weight management strategies.
If you’re taking a GLP-1 like Ozempic or Mounjaro for type 2 diabetes, nothing changes for you. Those drugs remain on the approved list for diabetes, and your coverage continues as long as your diagnosis supports it.
Why Medi-Cal Made This Change
The decision came directly from California’s 2025-26 state budget. GLP-1 medications are expensive, often costing over $1,000 per month at retail prices, and the number of people prescribed them has surged in recent years. With millions of Medi-Cal members potentially eligible, the cost to the state would be enormous. California isn’t alone in this. Many state Medicaid programs have limited or excluded weight loss drug coverage for the same budgetary reasons, even as private insurers have begun expanding access.