GLP Toolkit

PSW’s ForwardHealth Anti-Obesity Drug Coverage Toolkit is a practical guide to help pharmacists and care teams navigate Wisconsin Medicaid and SeniorCare coverage for anti-obesity medications. It summarizes key eligibility criteria, initial and renewal prior authorization steps, lifetime coverage rules, and special indications such as MACE, MASH, and OSA, using clear flowcharts and examples to support clinical decision-making. Download the toolkit to streamline PA requests and improve access to safe, effective weight-management therapies for your patients.

This toolkit is under revision. ForwardHealth published an update on Friday, June 19th, that details changes primarily related to the recent PDL cycle, which will be effective July 1, 2026. View ForwardHealth Update.

ForwardHealth has created a new Weight Management Agents class, and the only two products on the PDL in this class are the GLP-1s Foundayo and Zepbound. Prescribers will continue to directly submit PAs for these products, with DAPO being an option (pharmacies do not submit PAs/claims for these products). Detailed policy for these products and this class are on pages 4-6 of the Update. Zepbound will continue to be covered for obstructive sleep apnea.
Wegovy will still be covered for MACE and MASH, but will be limited in its coverage for weight loss. For weight loss, Wegovy is only covered for members 12-18. Pharmacies will submit all Wegovy claims. Detailed updated policy for Wegovy products can be found on pages 46-51 of the Update.
Other weight loss medications outside of the GLP-1s detailed in the first two bullets above will no longer be covered. A list of those products can be found on pages 38-39 of the Update.
For Wegovy for weight loss in adults 18 and older, as well as the other weight loss medications no longer covered as of July 1st, WI MA will honor all existing PAs approved prior to July 1st, but once the terms of those PAs end, a renewal/continued access to these products is no longer an option.