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Tennessee Medicaid

Does Tennessee Medicaid cover Zepbound?

Yes. Tennessee 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 documents

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

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

Full requirements: Zepbound 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 — 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 — 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 > 30 kg/m² (BMI-only pathway)
  • Medical records (e.g., chart notes) documenting BMI > 27 kg/m² with a weight-related comorbidity (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). No pediatric pathway exists for Zepbound (age minimum is 18). 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. The Zepbound OSA indication is not addressed in this document (only weight loss criteria are presented here).

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

Open on its own page →

Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Obstructive Sleep Apnea

All of:

  • Patient is 18 years of age or older
  • Diagnosis of moderate to severe Obstructive Sleep Apnea
  • Hypersomnolence secondary to another sleep disorder, neurologic disorder, medical condition, or medicine/substance use has been ruled out
  • Initial BMI ≥ 30 kg/m2 documented in medical records
  • Respiratory events ≥ 15 per hour of sleep confirmed by sleep study
  • Trial and failure of CPAP or BiPAP device with minimum 3-month duration with documented compliance, unless contraindicated
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Will not be used concomitantly with DPP-4 inhibitors
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Documentation to bring

  • Medical records (e.g., chart notes) documenting diagnosis of moderate to severe OSA
  • Sleep study results confirming ≥ 15 respiratory events per hour of sleep (AHI ≥ 15)
  • Medical records (e.g., chart notes) documenting initial BMI ≥ 30 kg/m2
  • Documentation ruling out hypersomnolence secondary to another sleep disorder, neurologic disorder, medical condition, or substance/medicine use
  • Documentation of CPAP or BiPAP trial failure with minimum 3-month duration and documented compliance, or documentation of contraindication to PAP therapy
  • Prescriber attestation that patient is participating in complementary nutritional and lifestyle changes
  • Documentation that patient has no personal or immediate family history of medullary thyroid carcinoma or MEN2

Quantity limits

  • 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg — 4 injectors

Approval and renewal

  • Renewal: Positive clinical response required: decrease in number of apneas and hypopneas during sleep from baseline. Lifestyle attestation IS re-verified at renewal. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal. CPAP/BiPAP trial requirement is not explicitly re-verified at renewal.

Not covered when

  • Personal or immediate family history of medullary thyroid carcinoma or MEN2
  • Concomitant use of DPP-4 inhibitors
  • Co-administration with another GLP-1 receptor agonist
  • Hypersomnolence attributable to another sleep disorder, neurologic disorder, medical condition, or medicine/substance use (must be ruled out)

Policy note: Moderate to severe OSA defined as ≥ 15 respiratory events per hour confirmed by sleep study (AHI ≥ 15). CPAP or BiPAP trial required for minimum 3 months with documented compliance unless contraindicated. Renewal requires documentation of decreased apneas and hypopneas from baseline plus lifestyle attestation re-verification. Quantity limit is 4 injectors per 28 days.

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

Open on its own page →

Questions people ask
Does Tennessee Medicaid cover Zepbound?
Yes. Tennessee 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.
What does Tennessee Medicaid require to renew Zepbound?
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. Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Positive clinical response required: decrease in number of apneas and hypopneas during sleep from baseline. Lifestyle attestation IS re-verified at renewal. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal. CPAP/BiPAP trial requirement is not explicitly re-verified at renewal.
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, Wegovy

Zepbound under other plans: Alabama Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Illinois Medicaid, Indiana Medicaid, Iowa Medicaid

All insurance plans · All medications

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