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Delaware Medicaid

Does Delaware Medicaid cover Wegovy for Weight Loss?

Yes. Delaware Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. 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: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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
  • Renewal: 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.

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: Delaware Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Delaware Medicaid cover Wegovy?
Yes. Delaware Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Delaware Medicaid?
Weight Loss — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Delaware Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. 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?
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, Ozempic, Zepbound

Wegovy under other plans: Highmark, Alabama 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.