Iowa Medicaid coverage for Ozempic (Type 2 Diabetes)

What you need to qualify

• Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• Current A1C lab result
• Documentation of FDA-approved indication and adherence to labeling (age, dosing, contraindications, warnings, drug interactions)
• If non-preferred: documentation of previous trials and therapy failures with preferred drug in the same class, including dates, dose, and nature of failure
• If non-preferred: documentation of previous trials and therapy failures with at least 3 preferred agents from 3 different drug classes at maximally tolerated doses, including dates, dose, and nature of failure

Not covered when

• Combination with DPP-4 inhibitor-containing agent will not be considered
• Pharmaceutical samples will not be considered when evaluating prior prescription history
• Duplicate use of drugs from the same therapeutic category will not be considered

Policy note: The document establishes PA criteria under the 'Anti-Diabetics, Non-Insulin Agents' section. GLP-1 receptor agonists are covered for Type 2 Diabetes Mellitus. Ozempic is included as a GLP-1 RA in this drug class per rule 27a class expansion. The policy explicitly states that weight loss is not a covered diagnosis; only the diabetes indication is covered. If Ozempic is a preferred agent, only the general criteria (criteria 1-3) apply. If non-preferred, criteria 4 (step therapy with 3 preferred agents from 3 different classes) also applies. Required trials must be at appropriate dose and duration and documented with dates, dose, and nature of failure. Trials may be overridden with documentation that use would be medically contraindicated.

Policy effective June 1, 2026 · verified June 4, 2026 · source: policy-387.html