Colorado Medicaid coverage for Wegovy (Liver

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

Colorado Medicaid coverage for Wegovy (Liver Disease (MASH))