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Connecticut Medicaid

Does Connecticut Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Connecticut Medicaid covers Wegovy for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

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

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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Questions people ask
Does Connecticut Medicaid cover Wegovy?
Yes. Connecticut Medicaid covers Wegovy for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.
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.