Applies to Medicaid plans.
Not coveredDocument explicitly states 'WEGOVY (SEMAGLUTIDE) INJECTION FORMULATION (NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS)' and 'WEGOVY (SEMAGLUTIDE) ORAL FORMULATION (NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS)'. No weight loss PA criteria are established; coverage is only available for CVD/MACE risk reduction and MASH indications.
Policy note: Explicitly not covered for weight loss as a standalone indication. Both injection and oral formulations carry the 'NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS' designation.
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)