Employer / Commercial Insurance
Covered with requirementsWhat you need to qualify
- Age 18 and older
- Confirmed MASH diagnosis, fibrosis stage F2 to F3
Qualification pathways
You can qualify through any one of these.
MASH with moderate to advanced liver fibrosis
All of:
- Adult patient (age >= 18)
- Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)
- Moderate to advanced liver fibrosis consistent with stages F2 to F3
Documentation to bring
- Documentation of noncirrhotic MASH diagnosis
- Documentation of liver fibrosis stage F2 to F3 (moderate to advanced fibrosis)
Not covered when
- Cirrhotic MASH is excluded (noncirrhotic only)
- Coadministration with other semaglutide-containing products is not recommended
- Coadministration with any other GLP-1 receptor agonist is not recommended
Policy note: FDA indication for MASH listed as subcutaneous injection formulation only (not tablet). Indication is for noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3). Specific confirmation methods, lookback periods, and alcohol use requirements are not enumerated in the provided document text — only the FDA indication summary is presented.
Policy effective April 20, 2026 · verified June 2, 2026 · source: ND_Weight_Management_PAQL_ProgSum.pdf