Skip to content
myglp1coverage.com

Kaiser Permanente Northern California · Liver Disease (MASH)

Kaiser Permanente Northern California coverage for Wegovy (Liver Disease (MASH))

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • 6 months of a documented diet and exercise program
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, and ELF_test, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH — Initial Approval

All of:

  • Age >= 18 years
  • Diagnosis of noncirrhotic MASH/NASH
  • Therapy prescribed by or in consultation with a hepatologist, gastroenterologist, or endocrinologist
  • Patient is enrolled in or has completed a lifestyle intervention (dietary, exercise, psychology)
  • Biopsy or non-invasive test (elastography or ELF testing) within the past 12 months demonstrating liver fibrosis stage 2 or 3
  • No concurrent use of Rezdiffra (resmetirom), another GLP-1 receptor agonist, or GLP-1/GIP receptor agonist

Documentation to bring

  • Documentation of age >= 18 years
  • Diagnosis of noncirrhotic MASH/NASH
  • Prescriber attestation or consultation note from hepatologist, gastroenterologist, or endocrinologist
  • Documentation of enrollment in or completion of a lifestyle intervention program (dietary, exercise, or psychology-based)
  • Liver biopsy or non-invasive test result (elastography/FibroScan or ELF blood test) within the past 12 months demonstrating fibrosis stage F2 or F3
  • Confirmation of no concurrent use of Rezdiffra (resmetirom), GLP-1 receptor agonist, or GLP-1/GIP receptor agonist

Approval and renewal

  • To renew, the plan looks for Renewal requires: (1) disease is stable or improved from baseline; (2) no concurrent use of Rezdiffra, GLP-1 agonist, or GLP-1/GIP agonist; (3) biopsy or non-invasive test (elastography or ELF) demonstrating fibrosis stage 2 or 3 — note the renewal fibrosis test does NOT specify a 12-month lookback (only the initial criteria do). Specialist prescribing/consultation and lifestyle program enrollment are NOT re-verified at renewal.

Not covered when

  • Cirrhotic liver disease (noncirrhotic MASH/NASH only)
  • Concurrent use of Rezdiffra (resmetirom)
  • Concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist (tirzepatide products)

Policy note: Fibrosis must be stage 2 or 3 (F2–F3). The policy explicitly requires 'noncirrhotic' MASH/NASH, excluding cirrhotic patients. At renewal, the 12-month lookback on the fibrosis test is not explicitly re-stated; renewal only requires evidence of fibrosis stage 2 or 3 without a specified timeframe. The mash_confirmation_methods list is inferred from the document's examples: 'elastography' maps to FibroScan_VCTE and 'Enhanced Liver Fibrosis [ELF] testing' maps to ELF_test; liver biopsy is also explicitly listed.

Policy effective June 1, 2026 · verified June 5, 2026 · source: Standard-Commercial-Guidelines-6-1-26-EXCERPTED.pdf

All Wegovy policies under Kaiser Permanente Northern California · Check your card