Does Centene Buckeye Health Plan Medicaid Ohio cover Qsymia?
Centene Buckeye Health Plan Medicaid Ohio excludes Qsymia from coverage— an exception may be available with clinical justification.
This plan explicitly excludes this medication from coverage. An exception may be available.
Verbatim status from policy: Excluded
Last verified 2026-04-30.
Requirements
- Prior authorization
- Not required
- Step therapy
- Not required
Sources
- Clinical Payment Policies | Ambetter from Buckeye Health Plan (including Centene Pharmacy Policies CP.PMN.295, CP.PCH.12, CP.PCH.13)
Ambetter from Buckeye Health Plan / Centene Corporation · Effective 2024-06-01 (Wegovy), 2025-01-01 (Plan EOC) · vCP.PMN.295 (rev 02-2026); CP.PCH.12 (rev 2017); CP.PCH.13 (rev 2017); CP.MP.37; CP.MP.40
- WellCare of Kentucky Medicaid Provider Manual; Kentucky Medicaid Prior Authorization Criteria (Wegovy/Zepbound)
WellCare of Kentucky (Centene) · Effective 2025-10-10 (Manual); 2026-01-03 (Wegovy PA); 2025-07-01 (Zepbound PA) · vEffective Oct 10, 2025 (Manual); Effective Jan 3, 2026 (Wegovy); Effective July 1, 2025 (Zepbound)
- 2025 FORMULARY (Ambetter from Buckeye Health Plan)
Ambetter from Buckeye Health Plan (Centene) · Effective 2025-01-01
- Bariatric Surgery; Medicare Coverage of Anti-Obesity Medications
Wellcare (Centene Corporation) · Effective 2025-05-01 (Policy WA.CP.MP.37); Last Revised 2024-03-24 (General CP.MP.37) · vCP.MP.37; WA.CP.MP.37; MI.CP.MP.37
- Clinical Policy: Bariatric Surgery
Centene Corporation (Buckeye Health Plan) · Effective 2026-02-26 · vCP.MP.37; rev 02/26
What to do next
Even when a plan says no, an exception or appeal is often possible — especially when there's a strong clinical case. Your prescriber can request a coverage determination.