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Wisconsin Medicaid

Does Wisconsin Medicaid cover Zepbound for Weight Loss?

Yes. Wisconsin 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 with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan · Medicaid card names in Wisconsin

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

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Pathway 1: BMI ≥ 30

All of:

  • Member is 18 years of age or older
  • BMI ≥ 30
  • Not pregnant or nursing
  • No history of eating disorder (anorexia, bulimia, binge eating disorder)
  • Prescriber evaluated and determined no medical or medication contraindications
  • Member has participated in a weight loss treatment plan in the past 6 months and will continue

Pathway 2: BMI 27-<30 with comorbidities

All of:

  • Member is 18 years of age or older
  • BMI ≥ 27 and < 30
  • Not pregnant or nursing
  • No history of eating disorder (anorexia, bulimia, binge eating disorder)
  • Prescriber evaluated and determined no medical or medication contraindications
  • Member has participated in a weight loss treatment plan in the past 6 months and will continue

Plus any one of:

  • Currently being treated for dyslipidemia AND at least one other qualifying risk factor
  • Currently being treated for hypertension AND at least one other qualifying risk factor
  • Currently being treated for sleep apnea AND at least one other qualifying risk factor
  • Currently being treated for type 2 diabetes mellitus AND at least one other qualifying risk factor
  • Has cardiovascular disease (history of MI, coronary revascularization, angina pectoris, stroke, intermittent claudication with ABI ≤ 0.9, peripheral arterial revascularization due to atherosclerotic disease, or amputation due to atherosclerotic disease) AND at least one other qualifying risk factor

Documentation to bring

  • Completed, signed, and dated Prior Authorization Drug Attachment for Anti-Obesity Drugs form (F-00163)
  • Documentation of member's current BMI
  • Documentation of qualifying comorbidities (if BMI 27-<30 pathway)
  • Documentation that member has participated in a weight loss treatment plan in the past 6 months
  • Prescriber attestation of no medical or medication contraindications
  • Confirmation member is not pregnant or nursing
  • Confirmation no history of eating disorder

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Member must achieve at least 5% weight loss from baseline. Member must be taking an appropriate maintenance dose as outlined in Zepbound prescribing information. PA will not be renewed if BMI falls below 24. Maximum treatment period is 12 continuous months; after that, member must wait 6 months before requesting again. ForwardHealth allows only two lifetime weight loss attempts with Zepbound.

Not covered when

  • Nursing (breastfeeding)
  • History of eating disorder (anorexia, bulimia, binge eating disorder)
  • Medical or medication contraindications as determined by prescriber
  • BMI below 24 at renewal — PA will not be renewed
  • Only one anti-obesity drug covered per member at a time
  • Maximum of two lifetime weight loss attempts with Zepbound
  • After 12 months of continuous treatment, must wait 6 months before requesting again
  • Pregnancy

Policy note: ForwardHealth (Wisconsin Medicaid). The document does not specify a pediatric BMI percentile threshold for Zepbound (only Wegovy/orlistat/phentermine-topiramate/Xenical are listed for the pediatric 95th percentile rule), and the general anti-obesity criteria specify age 18+ for the BMI 27-<30 pathway. Dual eligibles enrolled in Medicare Part D PDP are also covered for anti-obesity drugs.

verified June 3, 2026 · source: Wisconsin Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Wisconsin Medicaid cover Zepbound?
Yes. Wisconsin 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.
How long does a Zepbound approval last with Wisconsin Medicaid?
Weight Loss — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Wisconsin Medicaid require to renew Zepbound?
Weight Loss — Applies to Medicaid plans. Member must achieve at least 5% weight loss from baseline. Member must be taking an appropriate maintenance dose as outlined in Zepbound prescribing information. PA will not be renewed if BMI falls below 24. Maximum treatment period is 12 continuous months; after that, member must wait 6 months before requesting again. ForwardHealth allows only two lifetime weight loss attempts with Zepbound.
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.

Card and program names on file in Wisconsin

These names map to Wisconsin Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Wisconsin Medicaid: Mounjaro, Ozempic, Wegovy

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

All insurance plans · All medications

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