Fallon Health Plan coverage for Wegovy (Liver Disease (MASH))

What you need to qualify

• Confirmed MASH diagnosis, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• Diagnosis of NASH or MASH
• Documentation of fibrosis stage F2 or F3

Policy note: MASH indication for Wegovy was added January 5, 2026. The document describes coverage for 'moderate to advanced liver fibrosis' (F2 to F3). No additional details on confirmation methods, lookback periods, specialist requirements, alcohol limits, or approval duration were specified in this guideline update summary. Full criteria detail may exist in a separate policy document.

source: Pa policy