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Connecticut Medicaid

Does Connecticut Medicaid cover Wegovy?

No. Connecticut Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.

Policy document

  • Medicaid: Not covered. The document explicitly states: 'Wegovy will NOT be covered: Exclusively for weight management.'

Earliest policy review June 3, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Not covered

The document explicitly states: 'Wegovy will NOT be covered: Exclusively for weight management.'

Policy note: Wegovy is explicitly excluded when prescribed exclusively for weight management under this Connecticut Medicaid (HUSKY Health) policy.

Policy effective November 3, 2025 · verified June 3, 2026 · source: Get Download File · View policy document (PDF)

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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 – established major adverse cardiovascular event with valid diagnosis code

All of:

  • Established major adverse cardiovascular event (MACE)
  • Diagnosis code indicating established MACE submitted on PA form (from ctdssmap.com ICD-10-CM-Therapeutic Class Product Diagnosis List)

Documentation to bring

  • Completed existing 'WEGOVY for MACE (Major Adverse Cardiovascular Events)' prior authorization form
  • Valid ICD-10-CM diagnosis code indicating established major adverse cardiovascular event (from ctdssmap.com Pharmacy ICD-10-CM-Therapeutic Class Product Diagnosis List)

Policy note: The bulletin states the existing 'WEGOVY for MACE' PA form will continue to be available for clients meeting existing MACE criteria. Detailed MACE-specific coverage criteria are not restated in this bulletin — the bulletin only confirms the indication continues to exist and adds the new diagnosis code requirement effective November 3, 2025. Specific payable ICD-10 codes are published separately on ctdssmap.com. This entry reflects only what is explicitly stated in this bulletin.

Policy effective November 3, 2025 · verified June 3, 2026 · source: Get Download File · View policy document (PDF)

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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.

MASH – histologically confirmed with NAS, MELD, and liver enzyme criteria

All of:

  • Adult patient age 18 or older
  • Histologically documented steatohepatitis
  • NAFLD Activity Score (NAS) greater than or equal to 4
  • Hepatic decompensation or MELD score less than or equal to 12 points
  • AST and ALT levels less than or equal to 5 times upper limit of normal
  • Diagnosis code indicating established MASH submitted on PA form
  • Does NOT have Type 1 or Type 2 diabetes
  • Not prescribed exclusively for weight management

Documentation to bring

  • Completed 'Wegovy for MASH Prior Authorization Form'
  • Documentation of histologically documented steatohepatitis (liver biopsy)
  • NAFLD Activity Score (NAS) ≥ 4
  • Hepatic decompensation or MELD score ≤ 12
  • AST and ALT levels ≤ 5x upper limit of normal
  • Valid ICD-10-CM diagnosis code indicating established MASH (from ctdssmap.com Pharmacy ICD-10-CM-Therapeutic Class Product Diagnosis List)
  • PA form must be submitted for each new therapy request and annually thereafter

Approval and renewal

  • Renewal: every 12 months

Not covered when

  • Type 2 diabetes
  • Exclusively for weight management
  • Type 1 diabetes

Policy note: Document is a Connecticut Medicaid (HUSKY Health A, C, D) Provider Bulletin effective November 3, 2025. Diagnosis code is required in addition to prior authorization. PA must be submitted for new therapy and annually thereafter. The document does not specify explicit fibrosis staging (F1–F3) but requires histologic confirmation with NAS ≥ 4 and MELD ≤ 12. Specific payable ICD-10 codes are published separately on ctdssmap.com. Any PA form submitted without required information will be denied.

Policy effective November 3, 2025 · verified June 3, 2026 · source: Get Download File · View policy document (PDF)

Open on its own page →

If weight loss isn't covered on your plan

Connecticut Medicaid has separate Wegovy policies that don't depend on that benefit:

Questions people ask
Does Connecticut Medicaid cover Wegovy?
No. Connecticut Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.
How long does a Wegovy approval last with Connecticut Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Renewal: every 12 months.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Connecticut Medicaid: Mounjaro, Ozempic, Zepbound

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

All insurance plans · All medications

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