Colorado Medicaid

Does Colorado Medicaid cover Wegovy?

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Quick answer · Weight Loss

Colorado Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. BMI of 30 or higher

Last verified June 4, 2026. Policy effective March 1, 2023. Source: 04-01-26%20PDL%20V1.pdf. How we verify this data →

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Wegovy for Weight Loss

What Colorado Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 12 and older
  • BMI of 30 or higher
  • BMI of 27 or higher with a weight-related condition (HTN, T2DM, and dyslipidemia)

Qualification pathways

You can qualify through any one of these.

Adult weight loss (age >= 18)

All of:

  • Age >= 18 years
  • BMI >= 30 kg/m2 with no risk factors OR BMI >= 27 kg/m2 with at least one weight-related comorbid condition (hypertension, T2DM, or dyslipidemia)
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other weight loss drug(s)
  • Patient's baseline weight (in kg) submitted at time of request

Pediatric weight loss (age 12-17)

All of:

  • Age 12-17 years
  • BMI >= 30 kg/m2 AND body weight above 60 kg
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other weight loss drug(s)
  • Patient's baseline weight (in kg) submitted at time of request

Documentation to bring

  • Baseline BMI documentation (>= 30 kg/m2 without comorbidities, or >= 27 kg/m2 with qualifying comorbidity; >= 30 kg/m2 and weight > 60 kg for ages 12-17)
  • Patient's baseline body weight in kg
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
  • Documentation that no contraindications exist, or prescriber attestation that benefits outweigh risks
  • Confirmation of no concurrent use of other weight loss drugs

Quantity limits

  • all strengths — Per FDA-approved label

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, and Adults (>=18): at least 5% weight loss during initial approval period. Pediatric (12-17): at least 5% reduction in baseline BMI during initial approval period. Subsequent renewals (beyond 18 months) also require documentation that patient maintains weight loss achieved during the initial approval period. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • No concurrent use of any other weight loss drug(s)
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: Policy effective date listed for Anti-Obesity Medications section is March 2023; the Weight Management Agents section (which covers MACE, MASH, and OSA indications) is dated May 2026. Initial approval is 6 months; renewal is 12 months. After lapses in therapy, additional trials may be approved if initial criteria are met. Subsequent renewals beyond 18 months require meeting all renewal criteria plus documentation of maintained weight loss. The Anti-Obesity Medications PDL page lists Wegovy as a covered drug requiring PA.

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Wegovy for Heart Disease Risk Reduction

What Colorado Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Prescribed by or in consultation with a specialist
  • Established cardiovascular disease

Qualification pathways

You can qualify through any one of these.

MACE risk reduction

All of:

  • Requested drug is FDA approved for MACE
  • Diagnosis of obesity or overweight
  • Patient meets age limit in FDA-approved label
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
  • No concurrent use of any other GLP-1 receptor agonist
  • Diagnosis of established cardiovascular (CV) disease
  • Documentation of management of CV risk factors
  • Requested agent prescribed by or in consultation with a cardiologist

Documentation to bring

  • Confirmation that requested drug is FDA approved for MACE indication
  • Documentation of diagnosis of obesity or overweight
  • Documentation of established cardiovascular (CV) disease
  • Documentation of management of CV risk factors
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
  • Confirmation of no concurrent use of any other GLP-1 receptor agonist
  • Prescription or consultation note from a cardiologist

Quantity limits

  • all strengths — Per FDA-approved label

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Renewal criteria same as initial (up to 12 months per approval cycle). No separate continuation outcome requirements specified for MACE indication beyond re-meeting initial criteria.

Not covered when

  • No concurrent use of any other GLP-1 receptor agonist

Policy note: This criteria is from the Weight Management Agents section dated May 2026. The policy requires established CV disease and cardiologist involvement. Management of CV risk factors is required but specific GDMT medications are not enumerated. Approval is up to 12 months (initial and renewal per cycle).

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Wegovy for Liver Disease (MASH)

What Colorado Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH with moderate to advanced fibrosis

All of:

  • Requested drug is FDA approved for MASH
  • Patient meets age limit in FDA-approved label
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other GLP-1 receptor agonist
  • Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)
  • Moderate to advanced liver fibrosis consistent with stages F2 to F3
  • Requested agent prescribed by or in consultation with a gastroenterologist or hepatologist

Documentation to bring

  • Confirmation that requested drug is FDA approved for MASH indication
  • Documentation of diagnosis of noncirrhotic MASH
  • Documentation of liver fibrosis stage consistent with F2 to F3 (moderate to advanced fibrosis)
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
  • Documentation that no contraindications exist, or prescriber attestation that benefits outweigh risks
  • Confirmation of no concurrent use of any other GLP-1 receptor agonist
  • Prescription or consultation note from a gastroenterologist or hepatologist

Quantity limits

  • all strengths — Per FDA-approved label

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Renewal criteria same as initial (up to 12 months per approval cycle). No separate continuation outcome requirements specified for MASH indication beyond re-meeting initial criteria.

Not covered when

  • Cirrhotic MASH (must be noncirrhotic)
  • No concurrent use of any other GLP-1 receptor agonist
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: This criteria is from the Weight Management Agents section dated May 2026. The document requires F2-F3 fibrosis (moderate to advanced) and noncirrhotic MASH. Specific fibrosis confirmation methods (biopsy, FibroScan, FIB-4, etc.) are not enumerated in this policy. Specialist (gastroenterologist or hepatologist) involvement is required.

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Why Wegovy requests get denied by Colorado Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Qualifying weight-related condition not documented with its own diagnosis code.
  4. Prescriber isn't the specialist the plan requires.
  5. Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Colorado Medicaid cover Wegovy?
Colorado Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.
What BMI do you need for Wegovy under Colorado Medicaid?
For weight loss on Medicaid plans, Colorado Medicaid requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.
How long does a Wegovy approval last with Colorado Medicaid?
Initial approvals last 6 months, and renewals are granted in 12-month periods.
What does Colorado Medicaid require to renew Wegovy?
At least 5% weight loss from the starting weight, at least 5% reduction in BMI, and Adults (>=18): at least 5% weight loss during initial approval period. Pediatric (12-17): at least 5% reduction in baseline BMI during initial approval period. Subsequent renewals (beyond 18 months) also require documentation that patient maintains weight loss achieved during the initial approval period.
How current is this information?
This page reflects Colorado Medicaid's written policy as of March 1, 2023, last verified against the source document on June 4, 2026.

Other medications under Colorado Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Colorado Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.