Colorado Medicaid coverage for Wegovy (Heart Disease Risk Reduction)

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.

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