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Colorado Medicaid

Does Colorado Medicaid cover Wegovy?

Yes. Colorado Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Colorado

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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
  • Renewal: At least 5% reduction in BMI.
  • Renewal: 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.

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%20 Pdl%20 V1

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

Applies to Medicaid plans.

Covered with requirements

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
  • Renewal: 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%20 Pdl%20 V1

Open on its own page →

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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
  • Renewal: 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%20 Pdl%20 V1

Open on its own page →

Questions people ask
Does Colorado Medicaid cover Wegovy?
Yes. Colorado Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Colorado Medicaid?
Weight Loss — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Colorado Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. At least 5% reduction in BMI. 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. Heart Disease Risk Reduction — Applies to Medicaid plans. 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. Liver Disease (MASH) — Applies to Medicaid plans. 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.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Card and program names on file in Colorado

These names map to Colorado Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Colorado Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Alabama Medicaid, California Medicaid, Clover Health, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

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