California Medicaid

Does California Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

California Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. Diagnosis documented with a code

Last verified June 3, 2026. Policy effective April 6, 2026. Source: 12_A_GLP-1_Coverage_Considerations.pdf. How we verify this data →

Check your card for your exact plan →

Ozempic for Type 2 Diabetes

What California Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code

Qualification pathways

You can qualify through any one of these.

Type 2 diabetes — Code I diagnosis restriction must be met

All of:

  • Type 2 diabetes diagnosis (Code I diagnosis restriction)
  • Claim submitted with appropriate type 2 diabetes diagnosis code

Documentation to bring

  • Appropriate type 2 diabetes ICD-10-CM diagnosis code on claim (Code I diagnosis restriction)

Policy note: Ozempic remains on the CDL with a Code I diagnosis restriction of type 2 diabetes. Claims deny with Reject Code 80 when the Code I diagnosis restriction is not met. No longer eligible for weight loss or weight loss-related indications effective January 1, 2026. PA requests for non-weight-loss indications will be reviewed for medical necessity. Specific ICD-10 codes for type 2 diabetes are not enumerated in this document but are referenced as 'Code I diagnosis restriction'.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12_A_GLP-1_Coverage_Considerations.pdf

Why Ozempic requests get denied by California Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.
  2. Diagnosis code missing or wrong on the request.

Frequently asked questions

Does California Medicaid cover Ozempic?
California Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
How current is this information?
This page reflects California Medicaid's written policy as of April 6, 2026, last verified against the source document on June 3, 2026.

Other medications under California Medicaid

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes California Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.