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Tennessee Medicaid

Does Tennessee Medicaid cover Zepbound for Weight Loss?

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 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: 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)

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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.
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.