PA Medicaid ends coverage for obesity GLP-1 drugs

Pennsylvania’s Medical Assistance (MA) program will discontinue coverage for GLP-1 receptor agonists prescribed solely for weight management starting January 1, 2026. This policy update marks a reversal of the 2023 expansion when Medicaid began reimbursing these drugs for obesity treatment.

Details of the coverage change

Under the revised rules, GLP-1 drugs will remain covered only when prescribed for specific medical conditions such as type 2 diabetes, cardiovascular risk management, and certain liver or sleep-related disorders. Coverage will require prior authorization to confirm appropriate use. However, any use of GLP-1 medications exclusively for obesity, including the obesity-specific drug Saxenda (liraglutide), will no longer qualify for reimbursement under MA.

Non-GLP-1 obesity medications, like phentermine and other older treatments, will continue to be covered but remain subject to standard quantity and dosage limits. Providers and beneficiaries should anticipate the need to explore alternative treatments or navigate the prior authorization process where applicable.

Implications for providers and patients

This policy shift aligns with a broader national trend in response to rapidly increasing expenditures on GLP-1 weight-loss drugs such as Wegovy and Ozempic. Several states are reassessing Medicaid coverage to balance clinical benefits with budgetary constraints.

IDD providers and agencies serving Medicaid populations should review current prescribing patterns and prepare for adjustments. The removal of coverage for obesity-specific GLP-1s may affect care plans and require coordination to identify eligible therapeutic alternatives. Awareness of the restriction’s effective date is critical to ensure compliance and continuity of care.

Pennsylvania’s decision underscores the evolving landscape of Medicaid funding and reimbursement for costly specialty medications, emphasizing the need for ongoing monitoring of policy developments that impact IDD healthcare delivery.