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Florida Medicaid

Does Florida Medicaid cover Ozempic?

Yes. Florida Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Florida

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes (Preferred Agent)

All of:

  • Patient is ≥ 18 years of age
  • Diagnosis of type 2 diabetes mellitus
  • HbA1c ≥ 6.5% measured within the past 6 months (documentation required)
  • Trial and failure of metformin within the past 2 years, unless contraindicated or patient is intolerant (documentation required)

Documentation to bring

  • HbA1c lab result ≥ 6.5% within the past 6 months
  • Documentation of metformin trial and failure within the past 2 years, OR documentation of contraindication or intolerance to metformin

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: Documentation of improved clinical response (e.g., decline in HbA1c); patient has not experienced any treatment-restricting adverse effects; dosing is appropriate per labeling or supported by compendia. Initial BMI, metformin trial, and preferred agent step therapy are not re-verified at continuation.

Policy note: Ozempic is listed as a preferred agent requiring Clinical Prior Authorization. The metformin trial lookback window is 2 years. A1C lookback window is 6 months. Non-preferred agents (Rybelsus) require an additional step of trial and failure/adverse reaction/contraindication to preferred GLP-1s. Rybelsus (oral semaglutide) is a non-preferred agent in this policy; though it contains semaglutide, it does not meet the in-scope brand criteria for a separate criteria entry as it is not Ozempic or Wegovy.

Policy effective June 16, 2025 · verified June 4, 2026 · source: Glucagon Like%20 Peptide 1%20(GLP-1)%20 Receptor%20 Agonist%20and%20 Related%20 Agents%2003.12.2026

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Questions people ask
Does Florida Medicaid cover Ozempic?
Yes. Florida Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Florida Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Florida Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Documentation of improved clinical response (e.g., decline in HbA1c); patient has not experienced any treatment-restricting adverse effects; dosing is appropriate per labeling or supported by compendia. Initial BMI, metformin trial, and preferred agent step therapy are not re-verified at continuation.
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.

Card and program names on file in Florida

These names map to Florida Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Florida Medicaid: Mounjaro

Ozempic under other plans: Florida Blue, Molina Healthcare, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

Summary of Florida Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.