Does Centene cover Wegovy?

Yes. Centene covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

How long does a Wegovy approval last with Centene?

Liver Disease (MASH) — Applies to ACA Marketplace plans. Initial approval: 6 months. Renewal: every 12 months.

What does Centene require to renew Wegovy?

Liver Disease (MASH) — Applies to ACA Marketplace plans. After at least 12 months of therapy, member must show positive response evidenced by at least one of: (1) improvement in fibrosis ≥ 1 stage from baseline with no worsening of MASH (no worsening of hepatocellular ballooning, lobular inflammation, or steatosis); (2) resolution of MASH with no worsening of fibrosis; or (3) no increase in fibrosis stage and no worsening of MASH from baseline. Maintenance dose ≥ 1.7 mg/week required. Standard of care for concomitant conditions re-verified. Prior GLP-1 step therapy NOT re-checked at continuation. Staying on a maintenance dose of at least 1.7 mg.

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.

Centene coverage for Wegovy (Liver Disease (MASH))

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH — No Concurrent T2DM

All of:

Diagnosis of MASH (formerly NASH)
Request is for Wegovy injection (not tablets)
Prescribed by or in consultation with a hepatologist or gastroenterologist
Age ≥ 18 years
MASH with stage F2 or F3 fibrosis confirmed by liver biopsy within last 3 years OR both a serum-based assessment (e.g., FIB-4, NFS, ELF) AND imaging-based assessment (e.g., VCTE, MRE, MRI-PDFF) within the last 6 months
Prescriber attestation of current standard of care management for concomitant related conditions (T2DM, dyslipidemia, hypertension)
Active enrollment in physician-directed weight loss program for at least 6 months with plan to continue
Wegovy not prescribed concurrently with Rezdiffra (resmetirom)
Wegovy not prescribed concurrently with other semaglutide-containing products or any other GLP-1 receptor agonist
Dose within approved escalation schedule (up to 2.4 mg/week)

MASH — With Concurrent T2DM

All of:

Diagnosis of MASH (formerly NASH)
Request is for Wegovy injection (not tablets)
Prescribed by or in consultation with a hepatologist or gastroenterologist
Age ≥ 18 years
MASH with stage F2 or F3 fibrosis confirmed by liver biopsy within last 3 years OR both a serum-based assessment (e.g., FIB-4, NFS, ELF) AND imaging-based assessment (e.g., VCTE, MRE, MRI-PDFF) within the last 6 months
Trial of ≥ 3 consecutive months each of ALL of: Ozempic or Rybelsus, Trulicity, and liraglutide (generic Victoza), unless clinically significant adverse effects or all are contraindicated (Note: IL HIM requests exempt as of 1/1/2026 per IL HB 5395)
Prescriber attestation of current standard of care management for concomitant related conditions (T2DM, dyslipidemia, hypertension)
Active enrollment in physician-directed weight loss program for at least 6 months with plan to continue
Wegovy not prescribed concurrently with Rezdiffra (resmetirom)
Wegovy not prescribed concurrently with other semaglutide-containing products or any other GLP-1 receptor agonist
Dose within approved escalation schedule (up to 2.4 mg/week)

Documentation to bring

Diagnosis of MASH (chart documentation)
Documentation that request is for Wegovy injection formulation
Documentation that prescriber is a hepatologist or gastroenterologist, or that prescription is in consultation with one
Age verification ≥ 18 years
MASH fibrosis staging (F2 or F3) confirmed by: liver biopsy within last 3 years OR both a serum-based test (FIB-4, NFS, or ELF) AND an imaging-based test (VCTE, MRE, or MRI-PDFF) within the last 6 months
Prescriber attestation of current standard of care management for T2DM, dyslipidemia, and hypertension
Documentation of active enrollment in physician-directed weight loss program for at least 6 months
Confirmation that Wegovy is not prescribed concurrently with Rezdiffra
For concurrent T2DM: documentation of ≥ 3-month trial each of Ozempic/Rybelsus, Trulicity, and liraglutide (generic Victoza) (unless adverse effects or all contraindicated), except IL HIM as of 1/1/2026

Quantity limits

0.25mg, 0.5mg, 1mg
1.7mg, 2.4mg

Approval and renewal

Initial approval: 6 months
Renewal: every 12 months
Renewal: After at least 12 months of therapy, member must show positive response evidenced by at least one of: (1) improvement in fibrosis ≥ 1 stage from baseline with no worsening of MASH (no worsening of hepatocellular ballooning, lobular inflammation, or steatosis); (2) resolution of MASH with no worsening of fibrosis; or (3) no increase in fibrosis stage and no worsening of MASH from baseline. Maintenance dose ≥ 1.7 mg/week required. Standard of care for concomitant conditions re-verified. Prior GLP-1 step therapy NOT re-checked at continuation.
Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

Cirrhotic MASH (noncirrhotic only per FDA indication)
Concomitant use with Rezdiffra (resmetirom)
Concomitant use with other semaglutide-containing products
Concomitant use with any other GLP-1 receptor agonist
Wegovy tablets are not approved for MASH indication (injection only)
Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2 (contraindication)
Known hypersensitivity to semaglutide or excipients
Intolerance due to common GI adverse effects of GLP-1 class is NOT acceptable justification for bypassing step therapy

Exceptions

Illinois: Step therapy requirements for members with concurrent T2DM do not apply for Illinois HIM requests as of 1/1/2026 per IL HB 5395

Policy note: MASH is defined as ≥ 5% hepatic steatosis with inflammation and hepatocyte injury (ballooning), with or without fibrosis. Fibrosis confirmation methods include combined scores: FAST score (FibroScan + AST), MAST score (MRI-PDFF + MRE + AST), MEFIB score (FIB-4 + MRE). Wegovy injection only — tablets are NOT approved for MASH. Continued FDA approval for MASH indication may be contingent on confirmatory trial verification. Biopsy lookback was revised from 6 months to 3 years per AASLD guidance in the 09.09.25 revision.

Policy effective June 1, 2024 · verified June 2, 2026 · source: Cp.Pmn.295 · View policy document (PDF)

Does Centene cover Wegovy for Liver Disease (MASH)?

Policy document