Rhode Island Medicaid members who take Wegovy, Zepbound, Saxenda, or the new pill Foundayo only for weight loss can no longer get those drugs through the program as of Oct. 1, 2026. In a memo to providers, the state's Executive Office of Health and Human Services (EOHHS) said members using the drugs for weight loss "may no longer be able to obtain them through Medicaid beginning October 1, 2026."
Rhode Island Medicaid paid for 24,971 GLP-1 prescriptions for obesity in fiscal year 2025, Rhode Island Current reported. That count includes refills and changes in brand or dose, so it does not reflect the number of individual patients. Without coverage, the drugs carry list prices that can top $1,000 a month.
GLP-1 drugs prescribed for Type 2 diabetes remain covered.
Rhode Island Joins a Growing List of State Cutbacks
Rhode Island is at least the seventh state in 2026 to end or not renew Medicaid coverage of GLP-1s for obesity, according to Rhode Island Current, which listed California, New Hampshire, Pennsylvania, South Carolina, Utah, and Massachusetts as the others.
A KFF analysis published in January found that 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026. KFF said California, New Hampshire, Pennsylvania, and South Carolina had dropped that coverage since October 2025, while North Carolina ended it in October 2025 and reinstated it in December.
Pennsylvania's cut took effect Jan. 1 for adults 21 and older, according to the Pennsylvania Health Law Project. On July 1, MassHealth, Massachusetts' Medicaid program, stopped covering the drugs for weight loss for about 22,000 members, a move expected to save $15 million a year, Boston.com reported.
"Faced with an array of bad decisions, we tried to make the very best decisions that took care of the people that needed most to be taken care of," Massachusetts Gov. Maura Healey said in January about her budget choices.
Budget Math Behind the Decision
KFF found that gross Medicaid spending on GLP-1s nationwide grew about ninefold, from roughly $1 billion in 2019 to nearly $9 billion in 2024. That figure includes spending on the drugs for diabetes.
Rhode Island officials project the cut will save $6.3 million in state general revenue and $20.3 million once federal matching funds are included. A state budget document reported by Rhode Island Current said that "while quite efficacious, these medications are quite expensive," with list prices ranging from about $12,000 to $16,000 a year as of March 2025.
The same document acknowledged that ending coverage "could result in health inequities and less comprehensive coverage for a large segment of Rhode Island's population." It cited obesity rates of 38.5% among Black adults and 44.6% among adults in households earning under $15,000 a year.
Gov. Dan McKee included the cut in his proposed fiscal 2027 budget. EOHHS spokesperson Kerri White said there would be "no grandfathering or exemptions for existing patients," according to Rhode Island Current's January report.
"That's not the way to address a big public health problem. The big elephant in the room is the medications are too expensive," said Dr. Amy Nunn, executive director of the Rhode Island Public Health Institute.
What the Change Means for Members
Adults who used one of these drugs only to manage obesity face the most direct impact. For many Medicaid members, paying full price out of pocket is not realistic.
Members under 21 are handled differently. The Rhode Island EOHHS notice says all prior authorization requests for them must be reviewed for medical necessity under federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.
If one of the four drugs is medically necessary for a use other than weight loss, providers must submit a new prior authorization request with clinical documentation. The agency asked providers to "review your affected members' treatment plans and discuss alternative options, as appropriate, before the coverage change takes effect."
Members whose coverage is denied should contact their prescriber, who can review whether another diagnosis qualifies and file a prior authorization request. Patients should not stop or switch any medication without talking with a clinician. Members who believe they were wrongly denied can ask their health plan about their appeal rights.
Cost remains the main barrier for anyone who no longer qualifies. Manufacturer assistance programs can lower monthly costs to about $350 to $500, depending on the drug, Boston.com reported, which is still out of reach for many low-income households.
Prices may shift. In February, Novo Nordisk, which makes Wegovy, announced it would cut the list price of Wegovy and some of its other GLP-1 drugs to $675 a month in 2027, Stateline reported.
Key Questions Answered
What changed for Rhode Island Medicaid on Oct. 1? It stopped covering Wegovy, Zepbound, Saxenda, and Foundayo when they are prescribed solely for weight loss.
Does Rhode Island Medicaid still cover GLP-1 drugs for diabetes? Yes. GLP-1 drugs for Type 2 diabetes remain covered, and the four affected drugs can still be covered for other medically necessary uses through a new prior authorization request with clinical documentation.
Are children affected? For members under 21, every prior authorization request must get a medical necessity review under federal EPSDT requirements.
Which other states have dropped coverage? Rhode Island Current listed California, New Hampshire, Pennsylvania, South Carolina, Utah, and Massachusetts as states that ended or did not renew coverage in 2026.
What should affected patients do now? Talk with the prescribing clinician about other qualifying diagnoses, appeal rights, and manufacturer assistance programs.
Published by Medicaldaily.com
