Centene coverage for Ozempic (Kidney Disease (CKD))

ACA Marketplace

Covered with requirements

What you need to qualify

Age 18 and older
Diagnosis documented with a code

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
To renew, the plan looks for 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.pdf