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Colorado Medicaid

Does Colorado Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Colorado Medicaid covers Wegovy for heart disease risk reduction with prior authorization. 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 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

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Questions people ask
Does Colorado Medicaid cover Wegovy?
Yes. Colorado Medicaid covers Wegovy for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Colorado Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Colorado Medicaid require to renew Wegovy?
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.
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.