Does Virginia Medicaid cover Zepbound?

Quick answer · Weight Loss

Virginia Medicaid covers Zepbound for weight loss with prior authorization on Medicaid.

The card and program names below are mapped to Virginia Medicaid in our records. Coverage depends on the reason for treatment and the requirements in the policy.

Policy last verified June 4, 2026. Policy effective April 1, 2026. Source: VAmed-PDL-List-Criteria-20260401-v6.pdf. How we verify this data.

Card and program names on file in Virginia

Select a name to read the Virginia Medicaid policy for Zepbound. These are names we recognize, including older names and spelling variants; this is not a list of plans currently accepting members.

Don't see your card name? Check your card or call the pharmacy-benefit number on your card. If you also have Medicare, confirm which plan handles this prescription.

Zepbound for Weight Loss

Medicaid

Covered with requirements

No additional clinical requirements are listed beyond the diagnosis.

Documentation to bring

  • Weight Management Agents SA Form

Policy note: Zepbound is listed as a Non-Preferred agent under the Weight Management Agents CLOSED CLASS. The SA criteria reference a 'Weight Management Agents SA Form' for full clinical criteria details, which are not reproduced in this document. Authorization length is 'as indicated on fax form'. Note: the document states 'The selected GLP-1 Receptor Agonist is injectable brand Wegovy' in the context of the CV risk reduction and likely MASH SA forms, which may mean Zepbound is not the selected agent for those indications.

Policy effective April 1, 2026 · verified June 4, 2026 · source: VAmed-PDL-List-Criteria-20260401-v6.pdf

Zepbound for Osa

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosed obstructive sleep apnea

Documentation to bring

  • GLP-1 Receptor Agonist For Obstructive Sleep Apnea SA Form

Policy note: The document references a separate SA form titled 'GLP-1 Receptor Agonist For Obstructive Sleep Apnea SA Form'. Detailed clinical criteria are contained in the referenced fax form and not reproduced in this PDL document. Authorization length is 'as indicated on fax form'. Zepbound is listed as a Non-Preferred agent in the Weight Management Agents CLOSED CLASS section which references this OSA SA form.

Policy effective April 1, 2026 · verified June 4, 2026 · source: VAmed-PDL-List-Criteria-20260401-v6.pdf

Full Virginia Medicaid coverage page for Zepbound

Other medications under Virginia Medicaid

All insurance plans · All medications

This page summarizes written Medicaid policies on file. It is not a guarantee of coverage or medical advice. Confirm your current benefits and prior-authorization requirements with your plan.