The Wegovy Shutdown: Why Thousands of Pennsylvanians are Losing Medicaid Weight-Loss Coverage This January

In a significant move to "trim the fat" from the state's ballooning healthcare budget, the administration is significantly narrowing access to popular GLP-1 medications like Wegovy and Zepbound. If you or a loved one relies on these medications for weight management, here is precisely what is changing and how to prepare.

The $650 Million "Price Tag."

The decision to cut coverage wasn't made lightly, but the numbers tell a stark story. Since Pennsylvania began covering GLP-1s for weight loss in 2023, costs have skyrocketed.

• The Surge: In 2022, the state spent roughly $222 million on these drugs. By 2024, that number leaped to $650 million, with projections showing it could easily top $1 billion annually.
• The Goal: By restricting these drugs to those with specific medical needs, the state expects to save approximately $380 million through the next fiscal year.

The New Rules: Who Stays, Who Goes?

Starting January 1st, the Pennsylvania Medical Assistance (Medicaid) program will no longer cover GLP-1 drugs for the sole purpose of weight loss or obesity.

• The Cuts: If your prescription is for weight loss alone, your coverage will likely end on December 31, 2025. Notably, the drug Saxenda will be removed from coverage entirely for all indications.

• The Exception (Diabetes & Beyond): Coverage will remain for patients using these drugs to treat Type 2 Diabetes. Additionally, the state may still authorize coverage for patients with high-risk conditions, such as:

  
  
  

  • Severe Obstructive Sleep Apnea

  • Established Cardiovascular Disease (to reduce the risk of heart attack or stroke)

    
    
    

  • Specific chronic conditions where weight loss is a medical necessity for survival.

What Happens on January 1st?

It is important to note that this change is not a "grandfathered" transition.

1. Existing Authorizations Expire: All current prior authorizations for GLP-1 drugs will become invalid after December 31, 2025, regardless of your condition.
2. New Requests Required: If you qualify under the new, stricter guidelines (e.g., you have Type 2 Diabetes), your doctor must submit a new request for prior authorization to ensure your treatment isn't interrupted.

Are There Any Alternatives?

The state isn't abandoning obesity treatment entirely, but it is shifting back to more "traditional" (and affordable) options.

• Non-GLP-1 Medications: Older weight-loss agents that do not use GLP-1 technology—such as phentermine, orlistat, and diethylpropion—will remain covered as part of the state’s Preferred Drug List.
• Behavioral Support: The state continues to fund nutritional counseling and lifestyle modification programs as primary tools for weight management.

The Bottom Line

For many Pennsylvanians, these medications have been a "miracle" for health, but the state has deemed the current cost unsustainable. If you currently receive a GLP-1 through Medical Assistance, contact your doctor immediately to discuss your diagnosis and see if you qualify for a new authorization under the 2026 guidelines.