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California Medicaid

Does California Medicaid cover Zepbound?

No. California Medicaid's policies on file exclude Zepbound for weight loss on Medicaid plans.

Policy document

  • Medicaid: Not covered. Effective January 1, 2026, Zepbound has been removed from the Medi-Cal Rx Contract Drugs List (CDL) and is ...

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Zepbound for Weight Loss (1 plan type)

Applies to Medicaid plans.

Not covered

Effective January 1, 2026, Zepbound has been removed from the Medi-Cal Rx Contract Drugs List (CDL) and is no longer eligible for coverage for weight loss or weight loss-related indications. Claims will deny with Reject Code 70 – Product/Service Not Covered regardless of indication.

Exceptions

  • under_21_epsdt: Effective January 1, 2026, PA requests submitted for weight loss or weight loss-related indications will be reviewed for medical necessity for members younger than 21 years of age pursuant to the federal EPSDT benefit.

Policy note: Zepbound removed from CDL effective January 1, 2026. Claims deny with Reject Code 70 regardless of indication for weight loss. EPSDT exception for under-21 members.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12 A GLP-1 Coverage Considerations · View policy document (PDF)

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Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

OSA indication — PA considered

All of:

  • Obstructive sleep apnea (OSA) diagnosis

Documentation to bring

  • PA request for obstructive sleep apnea (OSA) indication

Policy note: Document states 'PA requests for Zepbound will be considered when used for obstructive sleep apnea (OSA).' No specific clinical criteria (AHI threshold, PAP trial, etc.) are defined in this document. Detailed criteria are presumably addressed elsewhere. Claims otherwise deny with Reject Code 70.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12 A GLP-1 Coverage Considerations · View policy document (PDF)

Open on its own page →

If weight loss isn't covered on your plan

California Medicaid has separate Zepbound policies that don't depend on that benefit:

Questions people ask
Does California Medicaid cover Zepbound?
No. California Medicaid's policies on file exclude Zepbound for weight loss on Medicaid plans.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under California Medicaid: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Elevance Health, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Molina Healthcare, Alabama Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

Summary of California Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.