Connecticut Medicaid

Does Connecticut Medicaid cover Wegovy?

Quick answer · Weight Loss

Connecticut Medicaid does not cover it for weight loss on Medicaid.

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

Last verified June 3, 2026. Policy effective November 3, 2025. Source: Get-Download-File. How we verify this data →

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Wegovy for Weight Loss

What Connecticut Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

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

Wegovy for Heart Disease Risk Reduction

What Connecticut Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code
  • Established cardiovascular disease (MACE)

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

Wegovy for Liver Disease (MASH)

What Connecticut Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Diagnosis documented with a code
  • Confirmed MASH diagnosis by liver_biopsy
  • Lab results confirming eligibility
  • Not being used to treat type 1 diabetes

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

Why Wegovy requests get denied by Connecticut Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  3. Diagnosis code missing or wrong on the request.

If weight loss isn't covered on your plan

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

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does Connecticut Medicaid cover Wegovy?
Connecticut Medicaid does not cover it for weight loss on Medicaid.
What if my plan excludes weight loss medications?
Connecticut Medicaid has separate Wegovy policies for heart disease risk reduction and liver disease (mash), which are covered on some plan types and don't depend on the weight-loss benefit. Wegovy is also available for cash through NovoCare.
How current is this information?
This page reflects Connecticut Medicaid's written policy as of November 3, 2025, last verified against the source document on June 3, 2026.

Other medications under Connecticut Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Connecticut Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.