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Tennessee Medicaid

Does Tennessee Medicaid cover Wegovy for Weight Loss?

Yes. Tennessee Medicaid covers Wegovy 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

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial Approval — Pediatric (< 18 years)

All of:

  • Age ≥ 12 years
  • Treatment is for management of obesity
  • BMI ≥ 95th percentile standardized for age and sex (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Initial Approval — Adult (≥ 18 years), BMI > 30

All of:

  • Age ≥ 18 years
  • Treatment is for management of obesity
  • BMI > 30 kg/m² (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Initial Approval — Adult (≥ 18 years), BMI > 27 with comorbidity

All of:

  • Age ≥ 18 years
  • Treatment is for management of obesity
  • BMI > 27 kg/m² (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Diabetes
  • Coronary heart disease
  • MASH/NASH
  • Obstructive sleep apnea

Renewal

All of:

  • Continued participation in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other obesity/weight loss medications
  • Documentation of ≥ 5% weight loss from baseline body weight

Documentation to bring

  • Medical records (e.g., chart notes) documenting BMI ≥ 95th percentile for age and sex (patients < 18 years)
  • Medical records (e.g., chart notes) documenting BMI > 30 kg/m² (adults ≥ 18 years, BMI-only pathway)
  • Medical records (e.g., chart notes) documenting BMI > 27 kg/m² with a weight-related comorbidity (adults ≥ 18 years, comorbidity pathway)
  • Prescriber attestation that patient is participating in complementary nutritional and lifestyle changes
  • At renewal: medical records (e.g., chart notes) documenting weight loss of ≥ 5% of baseline body weight

Quantity limits

  • all strengths — 4 injections/month

Approval and renewal

  • Renewal: Documentation of ≥ 5% weight loss from baseline body weight. Continued participation in complementary nutritional and lifestyle changes required. Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication.

Not covered when

  • Personal or immediate family history of medullary thyroid carcinoma (MTC)
  • Personal or immediate family history of multiple endocrine neoplasia type 2 (MEN2)
  • Concurrent use of other FDA-approved obesity/weight loss medications
  • Concurrent use of another GLP-1 receptor agonist

Policy note: PDL Status: Preferred (P). Document is TennCare PDL (Tennessee Medicaid). Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication. The lifestyle program attestation is required (prescriber-attested participation), not merely FDA label language — set requires lifestyle program: true. The document does not specify separate quantity limits by dose strength; a single limit of 4 injections/month applies to all strengths.

Policy effective June 1, 2026 · verified June 3, 2026 · source: Criteria Pdl · View policy document (PDF)

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Questions people ask
Does Tennessee Medicaid cover Wegovy?
Yes. Tennessee Medicaid covers Wegovy 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.
What does Tennessee Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. Documentation of ≥ 5% weight loss from baseline body weight. Continued participation in complementary nutritional and lifestyle changes required. Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Tennessee Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

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