MassHealth coverage change: anti-obesity medications

Effective July 1, 2026, in alignment with anticipated forthcoming changes to MassHealth regulations, we will no longer cover the following drugs when used for the treatment of obesity or overweight for members of our Tufts Health Together, Tufts Health Plan Senior Care Options, and Tufts Health One Care plans.

New prior authorizations needed for approved indications

Coverage of glucagon-like-peptide-1 (GLP-1) or GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 medications (e.g., Wegovy, Zepbound) will continue to be available after July 1 for members previously approved for the following other medically accepted indications, but a new prior authorization request will need to be submitted for these members: 

• established cardiovascular disease to reduce the risk of major adverse cardiovascular events (MACE)
• metabolic dysfunction-associated steatohepatitis (MASH)
• moderate to severe obstructive sleep apnea (OSA)

All requests for members under 21 years of age will be reviewed for medical necessity in accordance with Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.

Prior authorization timing: end dating versus review 

Prior authorizations submitted prior to Feb. 17, 2026 for all anti-obesity agents listed above, regardless of indication, will be end-dated as of June 30 and will need to be resubmitted for review. Members will be receiving letters if their current prior authorization is end-dated. 

Authorizations submitted between Feb. 17 and June 30, 2026 will be reviewed and processed based on the submitted indication.

Coverage for diabetes and prediabetes for Tufts Health Together 

For continued coverage as of July 1, members with a diagnosis of type 2 diabetes mellitus or prediabetes should be switched to an antidiabetic GLP-1. Refer to the MassHealth Drug List for current coverage of diabetic GLP-1 and GIP/GLP-1 agents and prior authorization criteria.

Zepbound/Wegovy step therapy for Tufts Health Together

For Tufts Health Together, effective for dates of service beginning July 1, 2026, Zepbound will no longer be considered a preferred drug; Wegovy will be the sole preferred drug for all medically accepted indications. All prior authorizations for continued treatment with Zepbound will require a trial with Wegovy for Tufts Health Together members.