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Delaware Medicaid

Does Delaware Medicaid cover Ozempic for Type 2 Diabetes?

Yes. Delaware Medicaid covers Ozempic for type 2 diabetes 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 4, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initial approval for T2DM

All of:

  • Diagnosis of type 2 diabetes mellitus (T2DM) with ICD-10 code provided
  • FDA-approved indication for the requested GLP-1 agonist
  • Dosage, frequency, and age within FDA-approved range
  • No contraindicated conditions or diseases with GLP-1 agonist therapy
  • Member is not currently on another GLP-1 agonist

Non-preferred agent request

All of:

  • All initial approval criteria met
  • Preferred GLP-1 agents have been tried and results documented in medical records

Documentation to bring

  • Member's relevant medical records and/or pharmacy profile
  • Appropriate baseline diagnostic and safety laboratory and/or noninvasive test results
  • ICD-10 diagnosis code for T2DM
  • Pharmacy claims history or pharmacy profile
  • Documentation that dosage, frequency, and age are within FDA-approved range
  • Documentation that member has no contraindicated conditions/diseases with GLP-1 agonist therapy
  • Documentation that member is not currently on another GLP-1 agonist
  • If brand name is medically necessary: MedWatch Form 3500
  • If non-preferred agent: documentation that preferred medications have been utilized with results

Quantity limits

  • all strengths — ≤30-day supply (initial and dose-change re-authorization); ≤90-day supply (re-authorization with no dose change) (84-day)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: Provider must document reason for dose change (titrating) or no dose change (maintenance). Change in dose: approval up to 1 month in ≤30-day supplies. No change in dose: approval up to 6 months in ≤90-day supplies.

Not covered when

  • Contraindicated conditions or diseases with GLP-1 agonist therapy
  • Currently on another GLP-1 agonist
  • Off-label/unapproved indications without two peer-reviewed articles demonstrating safety and efficacy

Policy note: This is a Delaware Medicaid (DMAP) PA request form for GLP-1 agonists for T2DM. The policy is class-level (all GLP-1 agonists for T2DM) and does not specify individual brand criteria. Initial authorization is for a 6-month trial dispensed in ≤30-day supplies. Re-authorization: dose change = up to 1 month in ≤30-day supplies; no dose change = up to 6 months in ≤90-day supplies. Preferred vs. non-preferred distinction exists but specific preferred agents are not listed in this document. Brand name medical necessity requires MedWatch Form 3500.

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 type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Delaware Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months.
What does Delaware Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Provider must document reason for dose change (titrating) or no dose change (maintenance). Change in dose: approval up to 1 month in ≤30-day supplies. No change in dose: approval up to 6 months in ≤90-day supplies.
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.