Do you have to try metformin before Ozempic?

Yes for type 2 diabetes: Florida Medicaid requires a documented trial of metformin of at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"]).

How long does a Ozempic approval last with Florida Medicaid?

Initial approvals last 12 months, and renewals are granted in 12-month periods.

What does Florida Medicaid require to renew Ozempic?

Improvement in A1C and 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?

This page reflects Florida Medicaid's written policy as of June 16, 2025, last verified against the source document on June 4, 2026.

Florida Medicaid

Does Florida Medicaid cover Ozempic?

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Quick answer · Type 2 Diabetes

Florida Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

Medicaid: Covered (preferred drug). A1C of 6.5% or higher

Last verified June 4, 2026. Policy effective June 16, 2025. Source: Glucagon-like%20Peptide-1%20(GLP-1)%20Receptor%20Agonist%20and%20Related%20Agents%2003.12.2026.pdf. How we verify this data →

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Ozempic for Type 2 Diabetes

What Florida Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered (preferred drug)

What you need to qualify

Age 18 and older
A1C of 6.5% or higher
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.

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
To renew, the plan looks for improvement in A1C and 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%20Peptide-1%20(GLP-1)%20Receptor%20Agonist%20and%20Related%20Agents%2003.12.2026.pdf

Why Ozempic requests get denied by Florida Medicaid

Based on what this policy asks for. Fix these before the first submission.

Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.
No recent A1C result on file.
No documented metformin trial (dose, dates, and outcome) or a stated reason it can't be used.

Frequently asked questions

Does Florida Medicaid cover Ozempic?: Florida Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
Do you have to try metformin before Ozempic?: Yes for type 2 diabetes: Florida Medicaid requires a documented trial of metformin of at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"]).
How long does a Ozempic approval last with Florida Medicaid?: Initial approvals last 12 months, and renewals are granted in 12-month periods.
What does Florida Medicaid require to renew Ozempic?: Improvement in A1C and 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?: This page reflects Florida Medicaid's written policy as of June 16, 2025, last verified against the source document on June 4, 2026.

Other medications under Florida Medicaid

Does Florida Medicaid cover Mounjaro?

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Florida Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.