MedicaidCoverageHigh impact
MassHealth coverage change: anti-obesity medications
Harvard Pilgrim Health Care·MA · Endocrinology, Family Medicine, Internal Medicine +2 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Effective July 1, 2026, MassHealth-affiliated plans (Tufts Health Together, Tufts Health Plan Senior Care Options, and Tufts Health One Care) will no longer cover anti-obesity medications including Wegovy, Zepbound, Saxenda, and others when used specifically for obesity treatment. GLP-1 medications will still be covered for diabetes, cardiovascular disease, MASH, and sleep apnea but will require new prior authorizations.
Action Required
By February 17, 2026: Billing team must identify all patients on anti-obesity medications covered by Tufts Health plans and coordinate with providers to either switch patients with diabetes/prediabetes to antidiabetic GLP-1s or resubmit prior authorizations for approved non-obesity indications (cardiovascular disease, MASH, sleep apnea). Before June 30, 2026: Update billing system to flag these medications as requiring prior authorization for non-obesity indications only. For Tufts Health Together members, prioritize Wegovy over Zepbound as preferred drug. Failure to obtain proper prior authorization will result in claim denials after July 1, 2026.