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 (Tufts Health Together, Senior Care Options, and One Care plans) will no longer cover anti-obesity medications including Wegovy, Zepbound, Saxenda, and others when used for obesity treatment. Coverage will continue for specific medical conditions (cardiovascular disease, MASH, sleep apnea) but requires new prior authorizations.
Action Required
By February 17, 2026: Billing team must identify all patients on anti-obesity medications with MassHealth plans and review their diagnoses. For patients with cardiovascular disease, MASH, or sleep apnea, submit new prior authorization requests. For diabetes/prediabetes patients, coordinate with providers to switch to antidiabetic GLP-1 medications per MassHealth Drug List. For Tufts Health Together members on Zepbound, ensure trial with Wegovy is documented. All existing prior authorizations end June 30, 2026 and must be resubmitted.