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Connecticut Medicaid · Heart Disease Risk Reduction

Connecticut Medicaid coverage for Wegovy (Heart Disease Risk Reduction)

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

All Wegovy policies under Connecticut Medicaid · Check your card