Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
- A1C of 7% or higher
- Diagnosis documented with a code
- Prior trial of 3 other GLP-1 medications (exenatide, Victoza, and Ozempic)
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
T2DM on background antidiabetic therapy with prior GLP-1 failure
All of:
- Age >= 18 years
- Diagnosis of type 2 diabetes mellitus
- HbA1c >= 7%
- Currently on metformin, SGLT2 inhibitor, sulfonylurea, or thiazolidinedione therapy
- Inadequate response, allergy, contraindication, drug-drug interaction, or intolerable side effects to exenatide, Victoza, AND Ozempic
Documentation to bring
- Documentation of type 2 diabetes mellitus diagnosis
- HbA1c lab result >= 7%
- Documentation of current background antidiabetic therapy (metformin, SGLT2 inhibitor, sulfonylurea, or thiazolidinedione)
- Documentation of inadequate response, allergy, contraindication, drug-drug interaction, or intolerable side effects to exenatide
- Documentation of inadequate response, allergy, contraindication, drug-drug interaction, or intolerable side effects to Victoza
- Documentation of inadequate response, allergy, contraindication, drug-drug interaction, or intolerable side effects to Ozempic
Policy note: Mounjaro is listed as non-preferred under Miscellaneous Antidiabetic Agents. Requires step therapy through all three prior GLP-1 agents: exenatide, Victoza, AND Ozempic. Quantity level limits are referenced externally at the Georgia MMIS portal and not included in this document.
Policy effective December 8, 2025 · verified June 4, 2026 · source: download