California Medicaid coverage for Zepbound (Weight Loss)

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.pdf