Medicaid coverage
Does New York Medicaid (NYRx) cover Saxenda?
Saxenda (liraglutide) for weight loss / obesity — the New York Medicaid (NYRx) prior-authorization rule, source-cited.
New York Medicaid (NYRx) Saxenda PA criteria
Weight loss is not and never has been a Medicaid-covered indication; GLP-1 agonists (including Ozempic, Wegovy, Mounjaro) are excluded from coverage for weight-loss indications (statutory exclusion under 18 NYCRR §505.3(g)(3) for anorexia, weight loss, or weight gain).
Zepbound, Saxenda, and tirzepatide do not appear on the PDL at all.
A narrow Wegovy CARDIOVASCULAR pathway exists (PDL p.74): lifetime quantity limit of two treatment attempts per lifetime; confirm a cardiovascular disease diagnosis; confirm patient BMI >=40; confirm participation in lifestyle modifications supporting cardiovascular health (the BMI >=40 applies ONLY to this CV pathway, not to weight loss).
Source: NYRx Drug Class Coverage Overview: GLP-1 Receptor Agonists - Type 2 Diabetes (Rev. 06/04/26) & NYRx PDL. View cited GLP-1 policy reference →
Frequently asked
- Does New York Medicaid (NYRx) cover Saxenda for weight loss / obesity?
- Typically not covered. Weight loss is not and never has been a Medicaid-covered indication; GLP-1 agonists (including Ozempic, Wegovy, Mounjaro) are excluded from coverage for weight-loss indications (statutory exclusion under 18 NYCRR §505.3(g)(3) for anorexia, weight loss, or weight gain). See the full source-cited criteria above. Per NYRx Drug Class Coverage Overview: GLP-1 Receptor Agonists - Type 2 Diabetes (Rev. 06/04/26) & NYRx PDL, as of 2026 (Coverage Overview & PDL Rev. 06/04/2026; doc dated 09/13/23) — confirm the member's current plan policy.
d3rx does not hold plan-specific pharmacy formularies or PBM prior-auth grids, so it cannot confirm a particular plan's GLP-1 coverage, tier, or PA criteria. The guidance below is the general, source-cited rule; confirm the specific plan's pharmacy formulary / PA policy for a binding answer.
Check Saxenda for another payer — or draft the PA
Run Saxenda + any payer in the GLP-1 PA lookup, or have Ask D3 draft a New York Medicaid (NYRx)-ready prior-authorization request with the right criteria and codes — free, no signup.