MassHealth recently announced changes to coverage for anti-obesity medications that are prescribed specifically for weight loss or obesity treatment.
Effective July 1, 2026, MassHealth will NO LONGER COVER the following medications for weight loss unless specific medical criteria are met:
- Wegovy (semaglutide)
- Zepbound (tirzepatide)
- Lomaira / Adipex-P (phentermine)
- Saxenda (liraglutide)
- Benzphetamine
- Diethylpropion
- Xenical (orlistat)
- Phendimetrazine
Beginning July 1, 2026, coverage may only continue if one of the following medical criteria is met:
- Body Mass Index (BMI) greater than 27 with established cardiovascular disease (coronary artery disease, cerebrovascular disease, peripheral artery disease)
- BMI greater than 30 with metabolic dysfunction-associated steatohepatitis (MASH) (moderate to advanced liver fibrosis)
- BMI greater than 30 with moderate to severe obstructive sleep apnea (as documented on a sleep test)
Please note that prior authorization requests will only be completed for patients who meet the MassHealth coverage criteria above and supportive documentation will be required. If the required criteria are not met, a prior authorization will not be submitted, as MassHealth will not approve coverage for the medication.
We understand this change may be upsetting and frustrating, especially for patients who have experienced success with these medications. Unfortunately, these coverage changes are being made by MassHealth and are not determined by your provider or the health center.
The HealthFirst team is happy to work with you to:
- Provide nutrition, lifestyle, and weight management support resources
- Review possible manufacturer savings programs if you choose to pay for the medication out of pocket
If you are interested in one of these two options, please send your provider a message or schedule an appointment to discuss.