How long does a Zepbound approval last with Delaware Medicaid?

Weight Loss — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.

What does Delaware Medicaid require to renew Zepbound?

Weight Loss — Applies to Medicaid plans. Adults must have lost ≥ 5% of baseline body weight; adolescents must have lost ≥ 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met.

How current is this information?

The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Delaware Medicaid coverage for Zepbound (Weight Loss)

Does Delaware Medicaid cover Zepbound for Weight Loss?

Yes. Delaware Medicaid covers Zepbound for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy document

Delaware Medicaid Medicaid prior authorization policy

Delaware Medicaid · PA policy · Medicaid

Effective April 20, 2026. Verified June 4, 2026.

View PDF Download Original insurer source

Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Obesity pathway (adult)

All of:

BMI ≥ 30 kg/m2
Adult member

Obesity pathway (pediatric)

All of:

BMI ≥ 95th percentile for age and weight
Pediatric member

Overweight with comorbidity (adult)

All of:

BMI ≥ 27 kg/m2 and < 30 kg/m2

Plus any one of:

Cardiovascular disease (CVD)
Heart failure
Chronic kidney disease stage 3a or above
Hypertension
Hyperlipidemia
Peripheral artery disease (PAD)
Moderate to severe OSA (AHI > 15 without central or mixed sleep apnea)
Type 2 diabetes

Documentation to bring

Member's relevant medical records and/or pharmacy profile
Appropriate baseline diagnostic and safety laboratory results with dates
Documentation of current weight, height, and BMI
Documentation of reduced calorie diet
Documentation of increased physical activity
If BMI is between 27-30 kg/m2: clinical co-morbid diagnosis with ICD-10 code
Confirmation that member is NOT currently on another GLP-1 agonist
Confirmation that member has no contraindicated conditions/medications with requested GLP-1
For non-preferred agent: documentation that preferred medications have been tried with results
Pharmacy claims history or pharmacy profile

Approval and renewal

Initial approval: 6 months
Renewal: every 6 months
Renewal: Adults must have lost ≥ 5% of baseline body weight; adolescents must have lost ≥ 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met.

Not covered when

Currently on another GLP-1 agonist
Has a contraindicated condition/disease with the requested GLP-1 agonist
Currently on a contraindicated medication with the requested GLP-1 agonist
Off-label indications without two peer-reviewed articles demonstrating safety and efficacy

Policy note: Class-level policy applies to all GLP-1 agonists. OSA as a qualifying comorbidity for the overweight pathway requires AHI > 15 without central or mixed sleep apnea (moderate to severe). Initial authorization up to 6 months in ≤ 30-day supplies; reauthorization 6 months in ≤ 90-day supplies.

Policy effective April 20, 2026 · verified June 4, 2026 · source: Delaware Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask

Does Delaware Medicaid cover Zepbound?: Yes. Delaware Medicaid covers Zepbound for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
How long does a Zepbound approval last with Delaware Medicaid?: Weight Loss — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Delaware Medicaid require to renew Zepbound?: Weight Loss — Applies to Medicaid plans. Adults must have lost ≥ 5% of baseline body weight; adolescents must have lost ≥ 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met.
How current is this information?: The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

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