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Illinois Medicaid

Does Illinois Medicaid cover Ozempic for Type 2 Diabetes?

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

Policy document

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

Earliest policy review June 4, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Pathway 1: T2DM without cardiovascular/renal comorbidities

All of:

  • Diagnosis of T2DM
  • Baseline labs (A1C within 3-6 months, A1C goal, eGFR/CrCL/Albumin)
  • Current HgbA1C above goal
  • A1C ≤ 10%
  • Requested medication is age-appropriate per Table 1
  • Ozempic has demonstrated cardiovascular benefits (non-preferred agent step therapy applies)
  • Ineffective treatment response to preferred injectable GLP1-RAs (Trulicity AND [Victoza OR liraglutide]) at optimized dose for at least 3 months OR documented intolerance/hypersensitivity/contraindication to preferred injectable GLP1-RAs

Plus any one of:

  • Ineffective treatment response to metformin at optimized dose for at least 3 months
  • Documented intolerance/hypersensitivity/contraindication to metformin

Pathway 2: T2DM with concurrent ASCVD or high risk of ASCVD

All of:

  • Diagnosis of T2DM
  • Baseline labs (A1C within 3-6 months, TC, LDL)
  • A1C ≤ 10%
  • Requested medication has demonstrated cardiovascular benefits per Table 1
  • Requested medication is age-appropriate per Table 1
  • Ineffective treatment response to preferred injectable GLP1-RAs (Trulicity AND [Victoza OR liraglutide]) at optimized dose for at least 3 months OR documented intolerance/hypersensitivity/contraindication to preferred injectable GLP1-RAs

Plus any one of:

  • Concurrent atherosclerotic cardiovascular disease (ASCVD)
  • High risk of ASCVD

Pathway 3: T2DM with concurrent CKD

All of:

  • Diagnosis of T2DM
  • Concurrent chronic kidney disease (CKD)
  • Baseline labs (A1C, GFR/CrCL/albuminuria)
  • A1C ≤ 10%
  • Requested medication has demonstrated CKD benefits per Table 1
  • Requested medication is age-appropriate per Table 1
  • Ineffective treatment response to preferred injectable GLP1-RAs (Trulicity AND [Victoza OR liraglutide]) at optimized dose for at least 3 months OR documented intolerance/hypersensitivity/contraindication to preferred injectable GLP1-RAs

Plus any one of:

  • Ineffective treatment response to metformin AND SGLT2-i (Invokana, Farxiga, or Jardiance) at optimized dose for at least 3 months
  • Documented intolerance/hypersensitivity/contraindication to metformin and/or SGLT2i

Pathway 4: T2DM with concurrent HFpEF and obesity

All of:

  • Diagnosis of T2DM
  • Concurrent symptomatic heart failure with preserved ejection fraction (HFpEF)
  • Obesity
  • Baseline labs (LVEF ≥ 50%, BMI/weight/height, A1C)
  • A1C ≤ 10%
  • Requested medication has demonstrated reduction of HF-related symptoms
  • Requested medication is age-appropriate per Table 1

Plus any one of:

  • Ineffective treatment response (HF-related symptom reduction) to two different preferred SGLT2-is (Invokana, Farxiga, or Jardiance) at optimized dose for at least 3 months
  • Documented intolerance/hypersensitivity/contraindication to SGLT2-i

Pathway 5: T2DM with concurrent MASLD/MASH

All of:

  • Diagnosis of T2DM
  • Concurrent MASLD or MASH
  • Biopsy-proven MASH
  • Baseline labs (LFTs, FIB-4, BMI)
  • A1C ≤ 10%
  • Requested medication is age-appropriate per Table 1

Plus any one of:

  • Ineffective treatment response to pioglitazone at optimized dose for at least 3 months AND ineffective treatment response to preferred GLP1-RA (liraglutide) at optimized dose for at least 3 months
  • Documented intolerance/hypersensitivity/contraindication to pioglitazone AND documented intolerance/hypersensitivity/contraindication to preferred GLP1-RA (liraglutide)

Documentation to bring

  • Baseline A1C lab result within 3-6 months
  • Documentation that current HgbA1C is above goal
  • Documentation that requested medication is age-appropriate (per Table 1)
  • Documentation of metformin trial at optimized dose for at least 3 months with inadequate response, OR documented intolerance/hypersensitivity/contraindication to metformin
  • Documentation of ineffective treatment response to preferred injectable GLP1-RAs (Trulicity AND [Victoza OR liraglutide]) at optimized dose for at least 3 months, OR documented intolerance/hypersensitivity/contraindication to preferred injectable GLP1-RAs (for non-preferred agent)
  • For ASCVD pathway: Baseline lipid labs (TC, LDL); documentation of concurrent ASCVD or high ASCVD risk; documentation that Ozempic has demonstrated CV benefits
  • For CKD pathway: Baseline GFR/CrCL/albuminuria labs; documentation of CKD; documentation that Ozempic has demonstrated CKD benefits; documentation of SGLT2i trial/failure or contraindication
  • For HFpEF pathway: LVEF ≥ 50% documentation; BMI/weight/height; documentation of HFpEF and obesity; documentation of SGLT2i trial/failure x2 or contraindication
  • For MASH pathway: LFTs, FIB-4, BMI; biopsy-proven MASH; documentation of pioglitazone trial/failure or contraindication; documentation of liraglutide trial/failure or contraindication

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: History of compliance and documented positive response to medication.

Not covered when

  • Concurrent use of DPP4-I, other GLP1-RA (oral or injectable), or GLP1/GIP
  • History of pancreatitis
  • Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2A/2B
  • HgbA1C > 10% in individuals with T2DM
  • Liver cirrhosis (for MASH diagnosis pathway)
  • Medication requested for obesity alone or in combination with another condition secondary to obesity (IL Medicaid policy)
  • Pregnancy
  • Type 1 diabetes

Policy note: Non-preferred agent on Illinois Medicaid PDL. Preferred agents are Trulicity (dulaglutide), Victoza (liraglutide), and liraglutide (generic) — all Step 4. Ozempic requires step therapy through preferred injectable GLP1-RAs. Step therapy requires trial of BOTH Trulicity AND (Victoza OR liraglutide) unless intolerance/contraindication documented. Obesity alone or secondary to another condition is explicitly excluded per IL Medicaid policy. Saxenda, Wegovy, and Zepbound are explicitly not covered. Initial approval is 30-day supplies for 6 months; renewal is 30-day supplies for 12 months. Table 1 referenced for age-appropriateness and cardiovascular/CKD benefit verification but not reproduced in this document.

Policy effective April 29, 2025 · verified June 4, 2026 · source: Policy 359 · View policy document (PDF)

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Questions people ask
Does Illinois Medicaid cover Ozempic?
Yes. Illinois 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 Illinois Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Illinois Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. History of compliance and documented positive response to medication.
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.

Also under Illinois Medicaid: Mounjaro, Wegovy, Zepbound

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

All insurance plans · All medications

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