How to read a state Medicaid preferred drug list

A preferred drug list is the document that turns a state's coverage policy into a yes or no at the pharmacy counter. It is public, it is usually a long PDF, and once you know the layout you can answer the GLP-1 question in two minutes.

Where it lives

Search the web for the state name, "Medicaid" and "preferred drug list". The result is on the state Medicaid agency site or on the site of the pharmacy benefit administrator the state contracts with (several states use a contractor, and the list is hosted there). Most states publish a PDF updated quarterly or twice a year, and a separate "PA criteria" or "clinical criteria" document. A few have a searchable web tool. The state page on this site links the state agency where a notice exists; otherwise start from the state Medicaid home page.

Check the date on the first page. Lists change on a schedule, and a list from before January 1, 2026 will be wrong for California, New Hampshire, Pennsylvania and South Carolina.

The three statuses

Drugs are grouped by therapeutic class, and within a class each product carries a status:

• Preferred. Covered without a class-level prior authorization, though a clinical PA can still apply to the drug itself. For an anti-obesity agent, a "preferred" status almost always still carries a PA edit.
• Non-preferred. Covered only after the preferred agents have been tried or are contraindicated, documented through a prior authorization. North Carolina's December 2025 notice is a clear example: Wegovy preferred, Zepbound and Saxenda non-preferred.
• Not covered or excluded. Not on the list at all, or listed under an excluded category. For weight-loss agents, absence usually means the state uses the federal exclusion for that indication.

The trap for GLP-1s is the class. Semaglutide appears twice: as Ozempic and Rybelsus under antidiabetics, and as Wegovy under anti-obesity agents (the class is variously named "weight loss agents", "anti-obesity agents", "GLP-1 agonists for weight management"). Tirzepatide appears as Mounjaro and as Zepbound. Read the obesity class. A preferred Ozempic tells you nothing about Wegovy.

The edits

Letters next to a product are the edits that apply even when it is covered:

• PA: prior authorization. Your prescriber submits a form against written criteria. The criteria document tells you the BMI threshold, the comorbidity list, any lifestyle-program documentation, and what is needed for renewal.
• QL: quantity limit, usually expressed per 28 or 30 days. For a weekly pen that is typically four pens.
• ST: step therapy. A cheaper or preferred agent must be tried first.
• Age: an age edit, for example 18 and over for the adult indication or 12 and over where the label allows adolescents.
• Dx or diagnosis restriction: coverage only when a listed diagnosis is on the claim, which is how a state covers semaglutide for diabetes while excluding it for obesity.

Managed care

Most members are in a managed-care plan. States handle this in one of three ways: the plan must follow the state list (a "uniform" or "single" PDL); the plan may run its own formulary as long as it is at least as generous; or the plan runs its own formulary within a state-approved framework. Your member card names the plan; the plan's site has a formulary, usually with the same status and edit vocabulary. When the state list and the plan formulary disagree, the plan's document governs your claim, and the plan's help line is the place to ask.

A worked reading

Suppose the anti-obesity class in a state list reads:

Read: the state covers GLP-1s for obesity. Wegovy is the first-line agent; a prior authorization against the criteria document is still required, and dispensing is capped per month. Zepbound is available after Wegovy has been tried (the ST edit) and only with a PA that documents that. Nothing here says what the criteria are; open the PA criteria document and search "Wegovy" for the BMI threshold and the renewal rule.

If the class is missing altogether, or the products appear under "excluded", the state is not covering the obesity indication. Look at the antidiabetic class to confirm Ozempic and Mounjaro are still there; they will be.

What the list will not tell you

It will not tell you what a compounded GLP-1 costs, because compounded semaglutide and tirzepatide are not FDA approved and do not appear on state lists. It will not tell you your plan's answer if your plan runs its own formulary. And it will not tell you tomorrow's policy; the Medicaid explainer shows how much moved between August 2025 and January 2026. For the state's current status with its source and date, use the state pages.