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Indiana Medicaid

Does Indiana Medicaid cover Ozempic for Type 2 Diabetes?

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

Policy document

  • 20260701 Public Facing GLP-1%20 Ra Gip Combinations PA Final

    Indiana Medicaid · PA policy · Medicaid

    Effective July 1, 2026. Verified June 4, 2026.

    View PDF Download Original insurer source
  • Medicaid: Covered (preferred drug). 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 (preferred drug)

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes (with or without CVD and/or CKD)

All of:

  • Member is 18 years of age or older
  • Diagnosis of type 2 diabetes mellitus confirmed by chart documentation or claims history
  • Baseline HbA1c submitted, obtained within past 90 days (lab documentation required)
  • Member is not on concomitant DPP-4 inhibitor-containing agent OR is transitioning from DPP-4 inhibitor (45-day transition permitted)
  • Member will not use concurrently with another GLP-1 RA or combination product
  • Dose does not exceed 2 mg/week

Plus any one of:

  • Previous trial of metformin for at least 90 days within past 120 days (confirmed by claims, chart, or provider attestation including dates)
  • Documented intolerance or contraindication to metformin therapy

Documentation to bring

  • Chart documentation or claims history confirming T2DM diagnosis
  • Baseline HbA1c lab result obtained within past 90 days
  • Claims history, chart documentation, or provider attestation of metformin trial ≥90 days within past 120 days (including dates of trial), OR documentation of metformin intolerance/contraindication
  • Documentation confirming no concomitant DPP-4 inhibitor use (or 45-day transition plan)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: HbA1c reduction from baseline OR trend toward stabilization over past year. If neither demonstrated, prescriber must submit medical justification with chart note support. HbA1c must be obtained within past 90 days (if on therapy <1 year) or within past 180 days (if on therapy ≥1 year). Must have history of requested agent for at least 84 days within past 112 days.
  • Renewal: At least 12 weeks on therapy before the first renewal.

Not covered when

  • No concurrent use with another GLP-1 RA or combination product
  • No concurrent DPP-4 inhibitor (45-day transition permitted)
  • Dose must not exceed 2 mg/week

Policy note: Preferred agent. Metformin trial must be within the past 120 days (not just any prior trial). Ozempic is also used as a preferred step-therapy prerequisite for non-preferred agents. At reauthorization, the 84-day history requirement uses a 112-day lookback window.

Policy effective July 1, 2026 · verified June 4, 2026 · source: 20260701 Public Facing GLP-1%20 Ra Gip Combinations PA Final · View policy document (PDF)

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Questions people ask
Does Indiana Medicaid cover Ozempic?
Yes. Indiana 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 Indiana Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Indiana Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. HbA1c reduction from baseline OR trend toward stabilization over past year. If neither demonstrated, prescriber must submit medical justification with chart note support. HbA1c must be obtained within past 90 days (if on therapy <1 year) or within past 180 days (if on therapy ≥1 year). Must have history of requested agent for at least 84 days within past 112 days. At least 12 weeks on therapy before the first renewal.
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 Indiana Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Elevance Health, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

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