Molina Healthcare coverage for Wegovy (Weight Loss)

In states where weight loss drugs are a benefit exclusion, Wegovy (semaglutide) injection and tablets are considered a benefit exclusion for all indications, including but not limited to weight reduction and chronic weight management. Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage. Wegovy (semaglutide) is excluded from coverage for overweight/obesity per Social Security 1927 (d)(3)(A) as an agent when used for anorexia, weight loss, or weight gain. California and New Mexico Marketplace have state-specific exceptions.

Exceptions

• California: Per California Title 28, plans are not required to cover weight loss drugs except when medically necessary for morbid obesity. Plans may require enrollment in a comprehensive weight loss program prior to or concurrent with the prescription. See Weight Management Therapy CA MMKP C28425-A.
• New Mexico: Prescription drugs medically necessary for the treatment of obesity and morbid obesity are covered. Treatments and medications for the purpose of weight reduction or control are not covered except for medically necessary treatment of morbid obesity and obesity. See Weight Management Therapy NM MMKP C29220-A.

Policy note: This is a Molina Healthcare Marketplace policy. Weight loss drugs are benefit exclusions under the Marketplace Evidence of Coverage and per Social Security 1927(d)(3)(A). California and New Mexico Marketplace have state-specific criteria referenced in separate policies. Phendimetrazine and phentermine are noted as on formulary for New Mexico.

Policy effective May 30, 2026 · verified June 11, 2026 · source: D84835628C9549BFB30D1D6F9EDBAC8E.ashx