Medicaid
Covered with requirementsNo 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