Texas is one of the most restrictive states for weight-loss drug coverage — anti-obesity GLP-1s simply aren't a covered Medicaid benefit here. The coverage that does exist is squarely a diabetes benefit. Here are the actual rules.
These GLP-1 (and GLP-1–containing) drugs can be covered for type 2 diabetes with an approved prior authorization:
Wegovy and Zepbound — the obesity-labeled versions of semaglutide and tirzepatide — are not covered for weight loss. (They appear in the criteria only to block taking two GLP-1s at once.)
Texas Medicaid's PA logic for a GLP-1 approval, step by step:
| Requirement | What it means |
|---|---|
| Age | 18 or older for most GLP-1s; 10 or older for Bydureon BCise, Trulicity and Victoza. |
| Type 2 diabetes diagnosis | A type 2 diabetes diagnosis on record within the last 365 days. No diabetes diagnosis, no approval. |
| Tried an oral diabetes drug | A history of an oral antidiabetic (metformin, a sulfonylurea, an SGLT2 like Jardiance or Farxiga, etc.) for at least 14 consecutive days in the last year — or a history of the requested GLP-1 itself for 14 days. (For Ozempic, Trulicity and Victoza, a history of heart disease, heart failure or chronic kidney disease can substitute.) |
| A recent A1c test | An HbA1c lab test on file within the last 180 days. |
| No safety contraindications | No history of pancreatitis, gastroparesis, end-stage renal disease, medullary thyroid cancer or MEN 2. |
| No duplicate therapy | You can't be approved for two GLP-1 drugs at the same time. |
One thing worth noting: unlike many commercial plans, Texas Medicaid's rule doesn't set a hard A1c cutoff (like "above 8%") — it requires that a recent A1c test exists, plus the diabetes diagnosis and prior oral therapy.
Tell us your plan, drug and reason, and see whether you're likely covered — plus exactly what your prescriber should document.
Check my coverageYes — for type 2 diabetes, with prior authorization. The PA checks for a type 2 diabetes diagnosis in the last year, a history of an oral diabetes drug (or the medication itself) for at least 14 consecutive days, and an A1c test within the last 180 days. Ozempic is not covered for weight loss.
No. Texas Medicaid does not cover anti-obesity GLP-1s like Wegovy or Zepbound for weight loss. Coverage for GLP-1 drugs is limited to type 2 diabetes.
Yes, for type 2 diabetes with prior authorization, under the same criteria as the other GLP-1s. Mounjaro (tirzepatide) is the diabetes brand; Zepbound is the weight-loss brand of the same molecule and is not covered for weight loss.
Texas Medicaid's criteria don't set a specific A1c number. They require that you have an A1c test on file within the last 180 days, along with a type 2 diabetes diagnosis and a history of an oral diabetes medication (or the requested drug) for at least 14 consecutive days.
Generally yes, or another oral diabetes drug. The criteria require a history of an oral antidiabetic agent — metformin, a sulfonylurea, an SGLT2 inhibitor, and similar — for at least 14 consecutive days in the last year. For Ozempic, Trulicity or Victoza, a history of heart disease, heart failure or chronic kidney disease can take the place of that step.
Related: Weight-loss coverage — the full guide · Does Medicare cover Wegovy? · California Medi-Cal · Florida Medicaid · GLP-1 coverage by insurer