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Fallon Health Plan

Does Fallon Health Plan cover Wegovy for Liver Disease (MASH)?

Yes. Fallon Health Plan covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Fallon Health Plan Medicaid prior authorization policy

    Fallon Health Plan · PA policy · Medicaid

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  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review May 25, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH with moderate to advanced liver fibrosis

All of:

  • Diagnosis of NASH or MASH
  • Moderate to advanced liver fibrosis (F2 to F3)

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: Fallon Health Plan Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Fallon Health Plan cover Wegovy?
Yes. Fallon Health Plan covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How current is this information?
The oldest review date among the policies on this page is May 25, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Fallon Health Plan: Ozempic

Wegovy under other plans: BCBS Massachusetts, Massachusetts Medicaid, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

Summary of Fallon Health Plan's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.