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Oregon Medicaid

Does Oregon Medicaid cover Zepbound for Weight Loss?

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

Policy document

  • Oregon%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026

    Oregon Medicaid · PA policy · Medicaid

    Effective March 1, 2026. Verified June 4, 2026.

    View PDF Download Original insurer source
  • Medicaid: Not covered. Document explicitly states: 'Tirzepatide is not currently covered for adults who do not have established ob...

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.

Not covered

Document explicitly states: 'Tirzepatide is not currently covered for adults who do not have established obstructive sleep apnea or type 2 diabetes.' Additionally: 'Drugs prescribed for only weight management (overweight or obesity) are NOT currently covered' (Table 3 note). Step 12 denial language: 'drugs are not covered by OHP for adults when indicated for weight loss.'

Policy note: Zepbound (tirzepatide) is explicitly not covered for adults when indicated solely for weight loss/obesity/overweight without an evidence-supported indication (OSA or T2DM). This applies to the Oregon Health Plan (Oregon Medicaid). Note: pediatric weight loss (EPSDT) coverage via Zepbound is not applicable as Table 1 indicates Zepbound (tirzepatide) is not FDA-approved for pediatrics.

Policy effective March 1, 2026 · verified June 4, 2026 · source: Oregon%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026 · View policy document (PDF)

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If weight loss isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Oregon Medicaid about a formulary exception.

Questions people ask
Does Oregon Medicaid cover Zepbound?
No. Oregon 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 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Oregon Medicaid: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Kaiser Permanente Northwest, Regence, Alabama Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Illinois Medicaid

All insurance plans · All medications

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