What BMI do you need for Wegovy under Delaware Medicaid?

For weight loss on Medicaid plans, Delaware Medicaid requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.

How long does a Wegovy approval last with Delaware Medicaid?

Initial approvals last 6 months, and renewals are granted in 6-month periods.

What does Delaware Medicaid require to renew Wegovy?

At least 5% weight loss from the starting weight and Adults must have lost >= 5% of baseline body weight; adolescents must have lost >= 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met.

How current is this information?

This page reflects Delaware Medicaid's written policy as of April 20, 2026, last verified against the source document on June 4, 2026.

Delaware Medicaid

Does Delaware Medicaid cover Wegovy?

Quick answer · Weight Loss

Delaware Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.

Medicaid: Covered with requirements. BMI of 30 or higher

Last verified June 4, 2026. Policy effective April 20, 2026. Source: Pa policy. How we verify this data →

Check your card for your exact plan →

Wegovy for Weight Loss

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

Medicaid

Covered with requirements

What you need to qualify

BMI of 30 or higher
BMI of 27 or higher with a weight-related condition (CVD, heart_failure, CKD, hypertension, hyperlipidemia, PAD, OSA, and T2DM)
BMI at or above the 95th percentile for age and sex
Diagnosis documented with a code
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Obesity pathway (adult)

All of:

BMI >= 30 kg/m2
Adult member

Obesity pathway (pediatric)

All of:

BMI >= 95th percentile for age and weight
Pediatric member

Overweight with comorbidity (adult)

All of:

BMI >= 27 kg/m2 and < 30 kg/m2

Plus any one of:

Cardiovascular disease (CVD)
Heart failure
Chronic kidney disease stage 3a or above
Hypertension
Hyperlipidemia
Peripheral artery disease (PAD)
Moderate to severe OSA (AHI > 15 without central or mixed sleep apnea)
Type 2 diabetes

Documentation to bring

Member's relevant medical records and/or pharmacy profile
Appropriate baseline diagnostic and safety laboratory results with dates
Documentation of current weight, height, and BMI
Documentation of reduced calorie diet
Documentation of increased physical activity
If BMI is between 27-30 kg/m2: clinical co-morbid diagnosis with ICD-10 code
Confirmation that member is NOT currently on another GLP-1 agonist
Confirmation that member has no contraindicated conditions/medications with requested GLP-1
For non-preferred agent: documentation that preferred medications have been tried with results
Pharmacy claims history or pharmacy profile

Approval and renewal

Initial approval: 6 months
Renewal: every 6 months
To renew, the plan looks for at least 5% weight loss from the starting weight and Adults must have lost >= 5% of baseline body weight; adolescents must have lost >= 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met. Make sure your starting weight and date are in the chart now — renewal is measured against it.

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
Off-label indications without two peer-reviewed articles demonstrating safety and efficacy

Policy note: Document is a class-level PA form for all GLP-1 agonists for weight management, MASH, or prevention of MACE from Delaware Medicaid (DMAP). Initial authorization is for up to 6 months in <= 30-day supplies. Re-authorization is for 6 months in <= 90-day supplies. Pediatric continuation threshold is >= 4% weight loss. If >50% of lost weight is regained or total weight loss is ever below threshold, PA may not be renewed for at least one year.

Policy effective April 20, 2026 · verified June 4, 2026 · source: Pa policy

Wegovy for Heart Disease Risk Reduction

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

Medicaid

Covered with requirements

What you need to qualify

BMI of 27 or higher
Diagnosis documented with a code
Established cardiovascular disease
Lab results confirming eligibility

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
To renew, the plan looks for 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)'. Requires BMI >= 27 kg/m2 and established CVD. No diabetes exclusion stated. 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: Pa policy

Wegovy for Liver Disease (MASH)

What Delaware 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
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, and MRE, fibrosis stage F2 to F3
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

MASH with moderate to advanced fibrosis

All of:

Moderate to advanced liver fibrosis consistent with stages F2 to F3
Fibrosis confirmed by biopsy OR non-invasive tests (e.g., FibroScan or MRE + MRI-PDFF)
Agent prescribed by or in conjunction with a hepatologist or gastroenterologist

Documentation to bring

Member's relevant medical records and/or pharmacy profile
Appropriate baseline diagnostic and safety biopsy, laboratory, and/or noninvasive test results confirming F2-F3 fibrosis
Documentation that agent is prescribed by or in consultation with a hepatologist or gastroenterologist (name and NPI of consulting provider required)
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
To renew, the plan looks for 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
BMI >= 27 kg/m2 is NOT required (obesity is a risk factor but not a requirement)

Policy note: MASH indication explicitly states BMI >= 27 kg/m2 is NOT a requirement. Fibrosis must be stages F2 to F3 (moderate to advanced). Non-invasive test examples include FibroScan or MRE + MRI-PDFF. Specialist (hepatologist or gastroenterologist) must prescribe or be consulted. 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: Pa policy

Why Wegovy requests get denied by Delaware Medicaid

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

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.
Diagnosis code missing or wrong on the request.
BMI not documented in the chart notes (or documented without a baseline weight and date).
Qualifying weight-related condition not documented with its own diagnosis code.
Prescriber isn't the specialist the plan requires.
Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Delaware Medicaid cover Wegovy?: Delaware Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.
What BMI do you need for Wegovy under Delaware Medicaid?: For weight loss on Medicaid plans, Delaware Medicaid requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.
How long does a Wegovy approval last with Delaware Medicaid?: Initial approvals last 6 months, and renewals are granted in 6-month periods.
What does Delaware Medicaid require to renew Wegovy?: At least 5% weight loss from the starting weight and Adults must have lost >= 5% of baseline body weight; adolescents must have lost >= 4% of baseline body weight. If more than 50% of lost weight is regained or total weight loss from baseline is ever < 5% (adults) or < 4% (adolescents), PA may not be renewed for at least one year. Initial approval re-documentation not required at reauthorization as long as weight loss threshold is met.
How current is this information?: This page reflects Delaware Medicaid's written policy as of April 20, 2026, last verified against the source document on June 4, 2026.

Other medications under Delaware Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Delaware 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.