Medicaid
Covered with requirementsWhat you need to qualify
- A1C of 5.7% or higher
- A1C no higher than 6.4%
- Diagnosis documented with a code
- Trial of metformin for at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"])
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
Prediabetes with metformin failure/intolerance/contraindication
All of:
- Diagnosis of prediabetes
- Baseline A1c >= 5.7% and < 6.5%
Plus any one of:
- Inadequate response to metformin at daily dose of 2000 mg/day
- Adverse reaction to metformin
- Contraindication to metformin at daily dose of 2000 mg/day
Documentation to bring
- Diagnosis of prediabetes
- Baseline A1c lab result (>= 5.7% and < 6.5%)
- Documentation of inadequate response to metformin at 2000 mg/day, OR adverse reaction to metformin, OR contraindication to metformin at 2000 mg/day
- For continuation: documentation of reduction in A1c or treatment plan to address A1c reduction
Approval and renewal
- To renew, the plan looks for improvement in A1C and Documentation of reduction in A1c or a treatment plan to address reduction in A1c.
Policy note: Prediabetes criteria for Ozempic aligned with Mounjaro, Trulicity, Victoza as of February 17, 2026. Requires diagnosis, baseline A1c, and inadequate response, adverse reaction, or contraindication to metformin at 2000 mg/day. This is listed in the anti-diabetic guideline section. Note: The JSON schema uses 'indication' enum values; prediabetes does not have a dedicated enum value so it is captured under 'diabetes' with notes. The a1c_min/a1c_max reflect the prediabetes diagnostic range.
source: Pa policy