Skip to content

Indiana Medicaid

Does Indiana Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. Indiana Medicaid covers Wegovy for liver disease (MASH) 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 with requirements. See the qualification pathways below.

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

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH Indication (Injection Formulation)

All of:

  • Member is 18 years of age or older
  • Diagnosis of MASH confirmed by qualifying diagnostic method
  • Prescribed by or in consultation with endocrinologist, gastroenterologist, or hepatologist
  • Not utilizing Wegovy concurrently with another GLP-1 RA or combination product (including semaglutide-containing products)
  • Prescriber attests member will use in combination with reduced calorie diet and increased physical activity
  • Dose does not exceed 2.4 mg/week

Plus any one of:

  • Liver biopsy within past 2 years: NAS ≥4 with ≥1 in each of steatosis, ballooning degeneration, and lobular inflammation AND METAVIR F2-F3 fibrosis with no evidence of cirrhosis
  • Fibroscan (VCTE) within past 6 months: LSM ≥9.1 kPa AND CAP ≥280 dB/m

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
  • Renewal: 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.
  • 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 (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%20 Ra Gip Combinations PA Final · View policy document (PDF)

Open on its own page →

Questions people ask
Does Indiana Medicaid cover Wegovy?
Yes. Indiana Medicaid covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Indiana Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Indiana Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. 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. 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.