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Centene

Does Centene cover Ozempic?

Yes. Centene covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

T2DM with MASLD and overweight/obesity

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • Diagnosis of MASLD
  • BMI 25-29.9 kg/m2 (overweight) or BMI ≥ 30 kg/m2 (obese)
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum (2 mg/week)
  • Failure of both preferred GLP-1s: liraglutide (Victoza) for ≥ 3 consecutive months, then Trulicity for ≥ 3 consecutive months, unless clinically significant adverse effects, both contraindicated, or member has CKD and request is for Ozempic injection (CKD exception bypasses step therapy for Ozempic injection)

T2DM with MASH

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • Diagnosis of MASH
  • Failure of ≥ 3 consecutive month trial of pioglitazone unless contraindicated or clinically significant adverse effects
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum (2 mg/week)
  • Failure of both preferred GLP-1s: liraglutide (Victoza) for ≥ 3 consecutive months, then Trulicity for ≥ 3 consecutive months, unless clinically significant adverse effects, both contraindicated, or member has CKD (CKD exception applies)

T2DM with ASCVD, high ASCVD risk, HFpEF, or CKD — agent with proven CV/renal benefit

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • Ozempic (injection or tablets) is an agent with proven cardiovascular or renal benefit
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum (2 mg/week injection or 9 mg/day tablets)

Plus any one of:

  • Established atherosclerotic cardiovascular disease (ASCVD)
  • Indicators of high ASCVD risk (per Appendix D)
  • Heart failure with preserved ejection fraction
  • Chronic kidney disease — with failure of ≥ 3 consecutive months of SGLT2 inhibitor or SGLT2-containing product unless clinically significant adverse effects or all contraindicated; NOTE: for Ozempic injection in CKD, step therapy through liraglutide/Trulicity is bypassed

T2DM without ASCVD, high ASCVD risk, HFpEF, CKD, MASLD, or MASH — non-GLP-1 step therapy

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • No established ASCVD, indicators of high ASCVD risk, heart failure with preserved ejection fraction, CKD, MASLD, or MASH
  • Failure of ≥ 3 consecutive month trial of two agents from any of the following classes: biguanides, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors or SGLT2 inhibitor-containing products, unless clinically significant adverse effects or all contraindicated
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum (2 mg/week injection or 9 mg/day tablets)
  • Failure of both preferred GLP-1s: liraglutide (Victoza) for ≥ 3 consecutive months, then Trulicity for ≥ 3 consecutive months, unless clinically significant adverse effects or both contraindicated

Documentation to bring

  • Office chart notes, lab results, or other clinical information supporting all approval criteria
  • Documentation of type 2 diabetes mellitus diagnosis
  • Documentation of member age (≥ 18 years)
  • Documentation of qualifying condition pathway (MASLD with overweight/obesity, MASH with pioglitazone trial/failure, ASCVD/high ASCVD risk/HFpEF/CKD with SGLT2i trial/failure, or two non-GLP-1 agent trial/failures)
  • Documentation of failure of liraglutide (Victoza) for ≥ 3 consecutive months (unless excepted; note CKD bypass for Ozempic injection)
  • Documentation of failure of Trulicity for ≥ 3 consecutive months after Victoza failure (unless excepted; note CKD bypass for Ozempic injection)
  • Confirmation that requested product is not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Member is responding positively to therapy. Continued therapy requires either (a) currently receiving medication via Centene benefit or previously met initial approval criteria, or (b) enrolled in a state with continuity of care regulations. No concurrent use with another GLP-1 or DPP-4 inhibitor.

Not covered when

  • Concurrent use with another GLP-1 receptor agonist
  • Concurrent use with a DPP-4 inhibitor
  • Dose exceeding FDA-approved maximum recommended dose
  • Type 1 diabetes

Policy note: Ozempic injection and Ozempic tablets (formerly Rybelsus R2 formulation, rebranded May 2026) are both covered for T2DM. Ozempic injection has a specific FDA indication for CKD — for CKD patients requesting Ozempic injection, the step therapy requirement through liraglutide (Victoza) and Trulicity is bypassed. Ozempic injection dosing note: for patients with T2DM and CKD, dose should be increased to maintenance dose of 1 mg once weekly after at least 4 weeks on 0.5 mg. Ozempic tablets (formerly Rybelsus R2) are not substitutable mg-per-mg with Ozempic injection. This policy covers both Ozempic injection and Ozempic tablets as non-preferred agents requiring step therapy except where CKD bypass applies.

Policy effective February 26, 2026 · verified June 2, 2026 · source: Cp.Pmn.183 · View policy document (PDF)

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Full requirements: Ozempic for Heart Disease Risk Reduction (1 plan type)

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV risk reduction in T2DM — established ASCVD or high ASCVD risk

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • Ozempic injection is FDA-approved for CV risk reduction in T2DM with established CVD; Ozempic tablets are approved for patients at high risk for major adverse CV events
  • Failure of ≥ 3 consecutive months of SGLT2 inhibitor or SGLT2-containing product unless clinically significant adverse effects or all contraindicated
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum
  • Failure of both preferred GLP-1s: liraglutide (Victoza) for ≥ 3 consecutive months, then Trulicity for ≥ 3 consecutive months (unless excepted)

Plus any one of:

  • Established atherosclerotic cardiovascular disease (ASCVD)
  • Indicators of high ASCVD risk (age ≥ 55 with coronary/carotid/lower-extremity artery stenosis >50%, LVH, retinopathy, other end organ damage)
  • Heart failure with preserved ejection fraction
  • Chronic kidney disease

Documentation to bring

  • Office chart notes or other clinical documentation of type 2 diabetes mellitus diagnosis
  • Documentation of established ASCVD, high ASCVD risk indicators, HFpEF, or CKD
  • Documentation of failure or contraindication/adverse effects for SGLT2 inhibitor trial ≥ 3 months
  • Documentation of failure of liraglutide (Victoza) ≥ 3 months (unless excepted)
  • Documentation of failure of Trulicity ≥ 3 months (unless excepted)
  • Confirmation of no concurrent GLP-1 receptor agonist or DPP-4 inhibitor use

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Member is responding positively to therapy. No concurrent use with another GLP-1 or DPP-4 inhibitor.

Not covered when

  • Concurrent use with another GLP-1 receptor agonist
  • Concurrent use with a DPP-4 inhibitor
  • Dose exceeding FDA-approved maximum recommended dose
  • Type 1 diabetes

Policy note: CV risk reduction for Ozempic is covered under the same T2DM criteria framework, specifically pathway I.A.3.d. Both Ozempic injection (established CVD) and Ozempic tablets (high CV risk) have FDA-approved CV indications. Coverage requires underlying T2DM diagnosis — this is not a standalone CV indication without diabetes. The policy does not separate CV risk reduction from diabetes management; both are handled under the T2DM approval pathway.

Policy effective February 26, 2026 · verified June 2, 2026 · source: Cp.Pmn.183 · View policy document (PDF)

Open on its own page →

Full requirements: Ozempic for Kidney Disease (CKD) (1 plan type)

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

T2DM with CKD — Ozempic injection only (step therapy bypassed)

All of:

  • Diagnosis of type 2 diabetes mellitus
  • Age ≥ 18 years
  • Diagnosis of chronic kidney disease
  • Request is for Ozempic injection (the only GLP-1 with FDA-approved CKD indication)
  • Failure of ≥ 3 consecutive months of SGLT2 inhibitor or SGLT2-containing product unless clinically significant adverse effects or all contraindicated
  • Not prescribed concurrently with another GLP-1 receptor agonist or DPP-4 inhibitor
  • Dose does not exceed FDA-approved maximum (2 mg/week)
  • Step therapy through liraglutide (Victoza) and Trulicity is BYPASSED for Ozempic injection in members with CKD

Documentation to bring

  • Office chart notes or clinical documentation of type 2 diabetes mellitus diagnosis
  • Documentation of chronic kidney disease diagnosis
  • Documentation of failure or contraindication/adverse effects for SGLT2 inhibitor trial ≥ 3 months
  • Confirmation of no concurrent GLP-1 receptor agonist or DPP-4 inhibitor use
  • Ozempic injection specified (not Ozempic tablets) — only injection has FDA-approved CKD indication

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Member is responding positively to therapy. No concurrent use with another GLP-1 or DPP-4 inhibitor.

Not covered when

  • Concurrent use with another GLP-1 receptor agonist
  • Concurrent use with a DPP-4 inhibitor
  • Dose exceeding FDA-approved maximum recommended dose
  • Type 1 diabetes

Policy note: Ozempic injection is the ONLY GLP-1 receptor agonist with an FDA-approved indication for CKD (to reduce risk of sustained eGFR decline, ESKD, and CV death in adults with T2DM and CKD). When requesting Ozempic injection for CKD, the step therapy requirement through liraglutide (Victoza) and Trulicity is explicitly bypassed per criterion I.A.4.d. Dosing for CKD patients: increase to maintenance dose of 1 mg once weekly after at least 4 weeks on 0.5 mg.

Policy effective February 26, 2026 · verified June 2, 2026 · source: Cp.Pmn.183 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Centene cover Ozempic?
Yes. Centene covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Centene?
Type 2 Diabetes — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Kidney Disease (CKD) — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Centene require to renew Ozempic?
Type 2 Diabetes — Applies to ACA Marketplace plans. Member is responding positively to therapy. Continued therapy requires either (a) currently receiving medication via Centene benefit or previously met initial approval criteria, or (b) enrolled in a state with continuity of care regulations. No concurrent use with another GLP-1 or DPP-4 inhibitor. Heart Disease Risk Reduction — Applies to ACA Marketplace plans. Member is responding positively to therapy. No concurrent use with another GLP-1 or DPP-4 inhibitor. Kidney Disease (CKD) — Applies to ACA Marketplace plans. Member is responding positively to therapy. No concurrent use with another GLP-1 or DPP-4 inhibitor.
How current is this information?
The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Centene: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Aetna, Cigna, Humana, UnitedHealthcare, Alabama Medicaid, Arkansas Medicaid, BCBS Alabama, BCBS Arizona

All insurance plans · All medications

Summary of Centene's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.