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Indiana Medicaid

Does Indiana Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Indiana Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. 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 with requirements. See the qualification pathways below.

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

Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CVD/MACE Risk Reduction in Obese or Overweight Individuals

All of:

  • Diagnosis of cardiovascular disease in obese or overweight individuals needing MACE risk reduction
  • Member is 45 years of age or older
  • BMI ≥ 27 kg/m2 (chart documentation within past 3 months)
  • Member does not have Type 1 or Type 2 diabetes (prescriber attestation)
  • Member will use in combination with reduced calorie diet and increased physical activity
  • Member will not use with other semaglutide products or any other GLP-1 RA or combination products
  • Dose does not exceed 2.4 mg/week

Plus any one of:

  • Prior myocardial infarction (MI) — supported by chart documentation within past year
  • Prior stroke (ischemic or hemorrhagic) — supported by chart documentation within past year
  • Symptomatic PAD: amputation due to atherosclerotic disease, OR history of peripheral arterial revascularization, OR intermittent claudication with ABI <0.85 at rest — supported by chart documentation within past year

Documentation to bring

  • Chart documentation confirming CVD diagnosis (obese or overweight, MACE risk reduction)
  • BMI documentation ≥ 27 kg/m2 obtained within past 3 months
  • Documentation of qualifying CVD event (prior MI, prior stroke, or symptomatic PAD) obtained within past year
  • Documentation of current GDMT use (beta-blockers and/or RAS inhibitors AND lipid-lowering agents) via chart documentation or claims history, OR medical justification why member cannot use these therapies (with dates of trial if applicable)
  • Prescriber attestation that member does not have T1D or T2D
  • Prescriber attestation of diet/physical activity use
  • Prescriber attestation of no concurrent GLP-1 RA or semaglutide products

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: At reauthorization: Prescriber attests member does not have T1D or T2D, member continues diet/physical activity, member will not use with other semaglutide/GLP-1 products. Member must continue GDMT (beta-blockers and/or RAS inhibitors AND lipid-lowering agents) or prescriber provides justification for inability to use GDMT. History of requested agent at least 84 days within past 112 days. No weight loss percentage threshold required at renewal. Age ≥45, BMI ≥27, and qualifying CVD event documentation are NOT re-verified at renewal per policy structure.
  • Renewal: At least 12 weeks on therapy before the first renewal.

Not covered when

  • Type 2 diabetes excluded
  • No concurrent use with other semaglutide products or any GLP-1 RA or combination products
  • Dose must not exceed 2.4 mg/week
  • Weight loss as the sole indication is explicitly not covered
  • Type 1 diabetes

Policy note: This entry covers the INJECTION formulation for CV risk reduction. There is also a separate ORAL formulation of Wegovy for CV risk reduction — see notes. Both formulations require the same CVD/MACE criteria. The oral formulation additionally requires medical justification for use over the subcutaneous injection. Wegovy is explicitly labeled 'NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS.' GDMT requirement includes beta-blockers and/or RAS inhibitors AND lipid-lowering agents; prescriber may provide justification for inability to use these. PAD qualifying criteria are detailed: amputation, revascularization history, or intermittent claudication with ABI <0.85.

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 Wegovy?
Yes. Indiana Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Indiana Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Indiana Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. At reauthorization: Prescriber attests member does not have T1D or T2D, member continues diet/physical activity, member will not use with other semaglutide/GLP-1 products. Member must continue GDMT (beta-blockers and/or RAS inhibitors AND lipid-lowering agents) or prescriber provides justification for inability to use GDMT. History of requested agent at least 84 days within past 112 days. No weight loss percentage threshold required at renewal. Age ≥45, BMI ≥27, and qualifying CVD event documentation are NOT re-verified at renewal per policy structure. 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, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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