Effective January 1, 2026, Medi-Cal Rx is excluding coverage for GLP-1 medications prescribed for weight loss: [12] Wegovy, Zepbound, Saxenda: Completely removed from the Contract Drugs List for weight loss Ozempic, Mounjaro, Rybelsus: Restricted to Type 2 diabetes onlyweight loss claims will auto-deny Existing prior authorizations end December 31, 2025 Exceptions: Members under age 21 may still qualify via EPSDT Non-weight-loss indications (Zepbound for OSA, Wegovy for cardiovascular) may still get PA approval This does NOT affect Kaiser commercial or employer-sponsored plansonly Medi-Cal members
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Although 5% weight loss did not show a net benefit, Moll and colleagues noted that it could be net beneficial for some individuals, depending on their willingness to accept the harm outcomes. For example, one of the harm outcomes that highly influenced the unfavorable benefit-harm balance of tirzepatide was alopecia, they explained
Understanding GLP-1 Maintenance Dosing After Weight Loss When we talk about tirzepatide and semaglutide maintenance doses, were referring to the amount of medication needed to keep your weight stable without continuing to lose weight
