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Medicaid coverage

Massachusetts: what Medicaid covers

MassHealth stopped paying for drugs used only to treat obesity or overweight on July 3, 2026, across every plan type. Four routes survive: cardiovascular risk at a BMI over 27, sleep apnea at a BMI over 30, MASH, and members under 21 under the federal EPSDT benefit.

Checked against the primary source August 25, 2026
What Medicaid in Massachusetts covers, and the criteria that apply.
Drug Position Criteria
Semaglutide Other indications only Sole preferred drug for the other approved indications from July 3, 2026 Changed July 3, 2026
Tirzepatide Other indications only Lost preferred status on July 3, 2026. Continuing treatment requires a trial of Wegovy Changed July 3, 2026
Liraglutide Not covered Listed among the anti-obesity medications MassHealth stopped paying for Changed July 3, 2026
If the answer is no. Around 45% of initial prior authorizations for these drugs are refused, and 35 to 45% of first-level appeals are overturned. A refusal is not the end of the process, and the cash-pay routes are priced on this site alongside it.

Sources

Every claim above is checked against the primary text, and the date is the day we last opened it.

  1. 1
    MassHealth Changes to Management of Anti-Obesity Medications Effective July 3, 2026

    MassHealth Pharmacy Program, Volume 16, Issue 7, May 2026 (Corrected) Primary text read and checked Checked August 25, 2026