Colorado Medicaid coverage for Wegovy (Weight Loss)

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