California Medicaid

Does California Medicaid cover Wegovy?

Quick answer · Weight Loss

California Medicaid does not cover it for weight loss on Medicaid.

  • Medicaid: Not covered. Effective January 1, 2026, Wegovy is no longer eligible for coverage for weight loss or weight loss-related indications.

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 →

Wegovy for Weight Loss

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

Medicaid

Not covered

Effective January 1, 2026, Wegovy is no longer eligible for coverage for weight loss or weight loss-related indications.

Exceptions

  • under_21_epsdt: Effective January 1, 2026, PA requests submitted for weight loss or weight loss-related indications will be reviewed for medical necessity for members younger than 21 years of age pursuant to the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

Policy note: Removal from coverage effective January 1, 2026. EPSDT exception applies for members under age 21.

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

Wegovy for Heart Disease Risk Reduction

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

Medicaid

Covered with requirements

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

Non-weight-loss indication (e.g., cardiovascular disease) — PA required, reviewed for medical necessity

All of:

  • PA request submitted for non-weight-loss-related cardiovascular disease indication
  • Medical necessity review required

Documentation to bring

  • PA request for cardiovascular disease or other non-weight-loss indication
  • Documentation supporting medical necessity

Policy note: Document states 'PA requests submitted for non-weight loss-related indications, such as cardiovascular disease, will be reviewed for coverage consideration based on medical necessity.' No specific clinical criteria are defined in this document; medical necessity review is indicated. PA is required.

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

Wegovy for Liver Disease (MASH)

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 (K76.0, K75.8)
  • Confirmed MASH diagnosis

Qualification pathways

You can qualify through any one of these.

MASH without cirrhosis — no PA required with correct diagnosis code

All of:

  • Noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) diagnosis
  • Claim submitted with ICD-10-CM diagnosis code K76.0 and/or K75.8

Documentation to bring

  • ICD-10-CM diagnosis code K76.0 (Fatty (change of) liver, not elsewhere classified) and/or K75.8 (Other specified inflammatory liver diseases) submitted on claim

Not covered when

  • Cirrhotic MASH not addressed; document specifies noncirrhotic MASH only

Policy note: Effective April 1, 2026. No PA required when claim is submitted with the appropriate ICD-10-CM diagnosis code (K76.0 and/or K75.8). Claims without the appropriate code will deny with Reject Code 80. Document does not specify detailed clinical criteria (fibrosis stage, confirmation methods, etc.) beyond the diagnosis code requirement.

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

Why Wegovy requests get denied by California Medicaid

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

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  3. Diagnosis code missing or wrong on the request.

If weight loss isn't covered on your plan

California Medicaid has separate Wegovy policies that don't depend on the weight loss benefit:

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does California Medicaid cover Wegovy?
California Medicaid does not cover it for weight loss on Medicaid.
What if my plan excludes weight loss medications?
California Medicaid has separate Wegovy policies for heart disease risk reduction and liver disease (mash), which are covered on some plan types and don't depend on the weight-loss benefit. Wegovy is also available for cash through NovoCare.
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

Wegovy 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.