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Delaware Medicaid

Does Delaware Medicaid cover Ozempic for Heart Disease Risk Reduction?

Yes. Delaware Medicaid covers Ozempic for heart disease risk reduction with prior authorization if your BMI is 27 or higher. 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 4, 2026. How we verify · Check your exact plan

Full requirements: Ozempic 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.

Prevention of MACE

All of:

  • BMI ≥ 27 kg/m2
  • Established cardiovascular disease (CVD)

Documentation to bring

  • Member's relevant medical records and/or pharmacy profile
  • Appropriate baseline diagnostic and safety laboratory results with dates
  • Documentation of BMI ≥ 27 kg/m2
  • Documentation of established CVD
  • Documentation of reduced calorie diet
  • Documentation of increased physical activity
  • Confirmation that member is NOT currently on another GLP-1 agonist
  • Confirmation that member has no contraindicated conditions/medications with requested GLP-1
  • Pharmacy claims history or pharmacy profile

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Prescriber must attest that the member continues to derive clinical benefit with the requested agent AND that the member requires ongoing therapy as part of the treatment plan. Resubmission of initial coverage documentation is NOT required at reauthorization.

Not covered when

  • Currently on another GLP-1 agonist
  • Has a contraindicated condition/disease with the requested GLP-1 agonist
  • Currently on a contraindicated medication with the requested GLP-1 agonist

Policy note: Policy refers to this indication as 'Prevention of Major Adverse Cardiovascular Events (MACE)'. Ozempic (semaglutide) is FDA-approved for CV risk reduction in T2DM patients with established CVD; the MACE criteria in this class-level policy require BMI ≥ 27 and established CVD. Initial authorization up to 6 months in ≤ 30-day supplies; reauthorization 6 months in ≤ 90-day supplies.

Policy effective April 20, 2026 · verified June 4, 2026 · source: Delaware Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Delaware Medicaid cover Ozempic?
Yes. Delaware Medicaid covers Ozempic for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Delaware Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Delaware Medicaid require to renew Ozempic?
Heart Disease Risk Reduction — Applies to Medicaid plans. Prescriber must attest that the member continues to derive clinical benefit with the requested agent AND that the member requires ongoing therapy as part of the treatment plan. Resubmission of initial coverage documentation is NOT required at reauthorization.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Delaware Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

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