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BCBS Arkansas · Liver Disease (MASH)

BCBS Arkansas coverage for Wegovy (Liver Disease (MASH))

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH with F2-F3 Fibrosis - Adult

All of:

  • Patient is an adult (18 years or older)
  • Request is NOT for Wegovy HD 7.2 mg injection OR Wegovy tablets
  • Used with a reduced-calorie diet AND increased physical activity
  • Diagnosis of noncirrhotic MASH (formerly NASH) with moderate to advanced liver fibrosis (stages F2 to F3)
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Moderate to advanced liver fibrosis (F2-F3) confirmed at baseline by non-invasive liver disease assessment (e.g., ultrasound-based elastography or MRE) OR historical liver biopsy

Documentation to bring

  • Documentation of baseline moderate to advanced liver fibrosis (F2-F3) confirmed by non-invasive liver disease assessment (ultrasound-based elastography or MRE) OR historical liver biopsy
  • Prescriber attestation of gastroenterologist or hepatologist involvement (prescribing or consulting)
  • Documentation of positive clinical response (e.g., reduction in ALT, improvement in ELF score, improvement in liver stiffness by elastography or MRE) (for continuation)

Quantity limits

  • 0.25mg/0.5mL, 0.5mg/0.5mL, 1mg/0.5mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens each) / 63 days (84-day)
  • 1.7mg/0.75mL, 2.4mg/0.75mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens each) / 63 days (84-day)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Patient must have achieved or maintained a positive clinical response (e.g., improvement in liver function such as reduction in ALT, improvement in ELF score, improvement in liver stiffness measurement by ultrasound-based elastography or MRE). Patient must be on a maintenance dose based on individual treatment response and tolerability. Documentation required. Note: initial fibrosis confirmation (F2-F3) and specialist requirement are not explicitly re-verified at continuation.

Not covered when

  • Wegovy HD 7.2 mg injection is explicitly excluded for the MASH indication
  • Wegovy tablets are explicitly excluded for the MASH indication
  • Cirrhotic patients are excluded (noncirrhotic MASH only)
  • Concomitant use with other semaglutide-containing products is not recommended
  • Concomitant use with any other GLP-1 receptor agonist is not recommended

Policy note: MASH indication is restricted to Wegovy injection (standard strengths only); Wegovy HD 7.2 mg injection and Wegovy tablets are explicitly excluded. No specific lookback periods are stated for fibrosis confirmation; historical biopsy is acceptable. Fibrosis confirmation methods include ultrasound-based elastography (FibroScan_VCTE), MRE, or historical liver biopsy. The policy notes this indication was approved under accelerated approval and continued approval may be contingent on confirmatory trial results. DOA is 12 months for both initial and continuation.

verified June 2, 2026 · source: 4774-C_Wegovy.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH with F2-F3 Fibrosis - Adult

All of:

  • Patient is an adult (18 years or older)
  • Request is NOT for Wegovy HD 7.2 mg injection OR Wegovy tablets
  • Used with a reduced-calorie diet AND increased physical activity
  • Diagnosis of noncirrhotic MASH (formerly NASH) with moderate to advanced liver fibrosis (stages F2 to F3)
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Moderate to advanced liver fibrosis (F2-F3) confirmed at baseline by non-invasive liver disease assessment (e.g., ultrasound-based elastography or MRE) OR historical liver biopsy

Documentation to bring

  • Documentation of baseline moderate to advanced liver fibrosis (F2-F3) confirmed by non-invasive liver disease assessment (ultrasound-based elastography or MRE) OR historical liver biopsy
  • Prescriber attestation of gastroenterologist or hepatologist involvement (prescribing or consulting)
  • Documentation of positive clinical response (e.g., reduction in ALT, improvement in ELF score, improvement in liver stiffness by elastography or MRE) (for continuation)

Quantity limits

  • 0.25mg/0.5mL, 0.5mg/0.5mL, 1mg/0.5mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens each) / 63 days (84-day)
  • 1.7mg/0.75mL, 2.4mg/0.75mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens each) / 63 days (84-day)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Patient must have achieved or maintained a positive clinical response (e.g., improvement in liver function such as reduction in ALT, improvement in ELF score, improvement in liver stiffness measurement by ultrasound-based elastography or MRE). Patient must be on a maintenance dose based on individual treatment response and tolerability. Documentation required. Note: initial fibrosis confirmation (F2-F3) and specialist requirement are not explicitly re-verified at continuation.

Not covered when

  • Wegovy HD 7.2 mg injection is explicitly excluded for the MASH indication
  • Wegovy tablets are explicitly excluded for the MASH indication
  • Cirrhotic patients are excluded (noncirrhotic MASH only)
  • Concomitant use with other semaglutide-containing products is not recommended
  • Concomitant use with any other GLP-1 receptor agonist is not recommended

Policy note: MASH indication is restricted to Wegovy injection (standard strengths only); Wegovy HD 7.2 mg injection and Wegovy tablets are explicitly excluded. No specific lookback periods are stated for fibrosis confirmation; historical biopsy is acceptable. Fibrosis confirmation methods include ultrasound-based elastography (FibroScan_VCTE), MRE, or historical liver biopsy. The policy notes this indication was approved under accelerated approval and continued approval may be contingent on confirmatory trial results. DOA is 12 months for both initial and continuation.

verified June 2, 2026 · source: 4774-C_Wegovy.pdf

All Wegovy policies under BCBS Arkansas · Check your card