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

What you need to qualify

• Age 18 and older
• 6 months of a documented diet and exercise program
• 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.

Documentation to bring

• Documentation of diagnosis of MASH (metabolic dysfunction-associated steatohepatitis), previously known as noncirrhotic nonalcoholic steatohepatitis (NASH)
• Documentation of moderate to advanced liver fibrosis consistent with stages F2 and F3
• Results from one qualifying non-invasive test (NIT): vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), or historical liver biopsy
• Confirmation that patient is 18 years of age or older
• Physician attestation or documentation that member is actively engaged in comprehensive lifestyle modification plan (reduced calorie diet, increased physical activity, behavioral modifications)
• For continuation: documentation of positive clinical response (MASH resolution with no worsening of liver fibrosis OR improvement in liver fibrosis)
• For continuation: physician attestation of continued active engagement in comprehensive lifestyle modification plan
• For continuation: documentation of FDA approved maintenance dose (1.7 or 2.4 mg subcutaneous injection)

Quantity limits

• all strengths — 1-month supply (28 to 30 days); 75% of days must be exhausted before refill

Approval and renewal

• Initial approval: 6 months
• Renewal: every 12 months
• To renew, the plan looks for Patient must have achieved or maintained a positive clinical response to therapy, such as MASH resolution with no worsening of liver fibrosis OR improvement in liver fibrosis. Patient must also be actively engaged in comprehensive lifestyle modification plan and be on FDA approved maintenance dose (1.7 or 2.4 mg subcutaneous injection) and staying on a maintenance dose of at least 1.7 mg.

Not covered when

• Wegovy oral tablet and Wegovy HD are NOT FDA approved for MASH — subcutaneous Wegovy only
• Cirrhotic NASH/MASH excluded (must be noncirrhotic)
• Mail order pharmacy benefit excluded
• Members with BCBSMA Focused Formulary: not a covered benefit effective 1/1/2026
• Requests based exclusively on use of samples will not meet coverage criteria

Policy note: Policy specifies F2 and F3 fibrosis only (moderate to advanced, noncirrhotic). F4 (cirrhosis) is not covered under this indication. No lookback period specified for biopsy or imaging. FIB-4 and ELF test are not listed as acceptable confirmation methods — only VCTE, MRE, and historical liver biopsy qualify. MASH indication applies only to subcutaneous Wegovy (not oral or HD formulations).

Policy effective May 1, 2026 · verified June 2, 2026 · source: 572%20GLP-1%20and%20GLP-1%20-%20GIP%20Agonist%20Drugs%20for%20Anti-Obesity%20Management%20and%20Other%20Non-Obesity%20Conditions.pdf