Indiana Medicaid coverage for Wegovy (Liver Disease (MASH))

What you need to qualify

• Age 18 and older
• Prescribed by or in consultation with a specialist
• Confirmed MASH diagnosis by liver_biopsy and FibroScan_VCTE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• Chart documentation or claims history confirming MASH diagnosis
• Liver biopsy report (within past 2 years) with NAS score components and METAVIR fibrosis stage (F2-F3, no cirrhosis), OR Fibroscan report (within past 6 months) with LSM >=9.1 kPa and CAP >=280 dB/m
• Documentation of prescribing/consulting specialist (endocrinologist, gastroenterologist, or hepatologist)
• For members with concomitant T2D: documentation of Ozempic at 2 mg/week for at least 18 months (claims or chart), plus baseline and current (within past 6 months) liver biopsy and/or non-invasive test results demonstrating inadequate fibrosis/steatosis reduction
• Documentation of concurrent Rezdiffra (resmetirom) use or absence thereof; if concurrent, prescriber medical justification required
• Prescriber attestation of diet/physical activity use

Approval and renewal

• Initial approval: 12 months
• Renewal: every 12 months
• To renew, the plan looks for At reauthorization: liver biopsy within past year demonstrating improvement or stabilization in fibrosis staging and NAS score from baseline, OR Fibroscan within past year demonstrating improvement or stabilization in CAP and LSM scores. Must have history of requested agent at least 84 days within past 112 days. No concurrent GLP-1 RA or semaglutide products. Prescriber attests continued diet/physical activity and at least 12 weeks on therapy before the first renewal.

Not covered when

• No concurrent use with another GLP-1 RA or combination product (including semaglutide-containing products)
• Concurrent use with Rezdiffra (resmetirom) requires prescriber medical justification
• Members with T2D must have failed Ozempic 2 mg/week for >=18 months with documented inadequate fibrosis/steatosis reduction before Wegovy can be used for MASH
• No evidence of cirrhosis (biopsy criterion)
• Dose must not exceed 2.4 mg/week

Policy note: Wegovy MASH criteria (injection formulation) require METAVIR F2-F3 (no cirrhosis) — stricter fibrosis staging than Ozempic MASH criteria (F1-F3). Fibroscan thresholds also differ: Wegovy requires LSM >=9.1 kPa and CAP >=280 dB/m; Ozempic MASH requires LSM >=6.43 kPa and CAP >=238 dB/m. Members with concomitant T2D face an additional hurdle: must have been on Ozempic 2 mg/week consistently for >=18 months with demonstrated inadequate response. Concurrent Rezdiffra use requires justification. Initial approval is 1-year. Specialist required.

Policy effective July 1, 2026 · verified June 4, 2026 · source: 20260701_Public-Facing_GLP-1%20RA-GIP-Combinations_PA_Final.pdf