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Does Clover Health cover Ozempic for Kidney Disease (CKD)?

Yes. Clover Health covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Clover Health Medicare Advantage prior authorization policy

    Clover Health · PA policy · Medicare Advantage

    View PDF Download
  • Medicare Advantage: Covered with requirements. See the qualification pathways below.

Earliest policy review April 1, 2026. How we verify · Check your exact plan

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

Applies to Medicare Advantage plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CKD with T2DM - renal and CV risk reduction

All of:

  • Documented lifestyle modifications (nutrition therapy, physical activity, diabetes self-management) attempted
  • Confirmed T2DM diagnosis by one of: HbA1c ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dL, or 2-hr plasma glucose ≥ 200 mg/dL during OGTT (with dates)
  • Chronic kidney disease (CKD) with GFR < 60 mL/min/1.73 m2
  • Patient is on maximally tolerated dose of ACE inhibitor or ARB

Documentation to bring

  • Documentation that lifestyle modifications (nutrition therapy, physical activity, diabetes self-management) have been attempted
  • Lab results confirming T2DM diagnosis: HbA1c ≥ 6.5%, OR fasting plasma glucose ≥ 126 mg/dL, OR 2-hr plasma glucose ≥ 200 mg/dL during OGTT (with dates for all labs)
  • Lab result confirming CKD with GFR < 60 mL/min/1.73 m2
  • Documentation of current ACE inhibitor or ARB use at maximally tolerated dose

Approval and renewal

  • Renewal: Therapy discontinuation should be considered if HbA1c is not at goal after 6 months of appropriate use or if patient has intolerable side effects.

Not covered when

  • History of medullary thyroid carcinoma (contraindication)
  • Multiple endocrine neoplasia type 2 / MEN2 (contraindication)
  • Weight loss/obesity as sole indication (excluded from Medicare Part D coverage)

Policy note: CKD indication for Ozempic is listed within the T2DM PA pathway as an AND/OR qualifying criterion. Policy specifies 'reduction of risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with T2DM.' Requires CKD (GFR < 60 mL/min/1.73 m2) on maximally tolerated dose of ACEi or ARB. This pathway does not explicitly require a metformin trial failure, as it is presented as an AND/OR alternative. No UACR threshold specified in this policy document.

source: Clover Health Medicare Advantage prior authorization policy · View policy document (PDF)

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Questions people ask
Does Clover Health cover Ozempic?
Yes. Clover Health covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.
What does Clover Health require to renew Ozempic?
Kidney Disease (CKD) — Applies to Medicare Advantage plans. Therapy discontinuation should be considered if HbA1c is not at goal after 6 months of appropriate use or if patient has intolerable side effects.
How current is this information?
The oldest review date among the policies on this page is April 1, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Clover Health: Wegovy

Ozempic under other plans: Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

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