As of October 1, 2026, Rhode Island Medicaid no longer covers Wegovy, Zepbound, Saxenda, or Foundayo when prescribed solely for weight loss.
Coverage Details
- No Grandfathering: State officials confirmed there are no exemptions for existing patients.
- Diabetes Exception: These medications remain covered when prescribed for type 2 diabetes, subject to prior authorization.
- Children (Under 21): PA requests must still be reviewed for medical necessity in accordance with Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.
Source: RI EOHHS Memorandum (Aug 5, 2026).
What to do if you lost coverage
Talk to your prescriber about alternatives. If you are now self-pay, manufacturer-direct programs (like LillyDirect or NovoCare) often offer the most reliable cash-pay pricing for branded medications. Note: Discount cards often restrict use for patients on government insurance; verify eligibility for any savings program carefully.
Verification needed for state-by-state cut list, projected savings, and current list-price claims.
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