Skip to content

Kansas Medicaid

Does Kansas Medicaid cover Ozempic?

Yes. Kansas Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

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

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Glycemic control in T2DM

All of:

  • Diagnosis of T2DM
  • Age ≥ 18 years
  • Prescriber provides prespecified HbA1c goal of 6.5%, 7.0%, or 8.0%
  • Baseline HbA1c obtained within past 6 months that is greater than the prespecified goal
  • Dose does not exceed 2 mg SQ weekly
  • Patient is not currently on a DPP-4 inhibitor
  • Preferred PDL drug trial completed unless non-preferred PDL PA criteria met

Plus any one of:

  • Adequate trial of generic metformin IR or metformin ER for at least 90 consecutive days in the past 120-day period
  • Prescribed generic metformin IR or ER concurrently with requested drug AND HbA1c ≥ 1.5% above prespecified goal
  • Contraindication to metformin

Documentation to bring

  • Prescriber-specified HbA1c goal (6.5%, 7.0%, or 8.0%)
  • Baseline HbA1c lab result obtained within the past 6 months showing value greater than the prespecified goal
  • Documentation of metformin trial (≥90 consecutive days in past 120 days), concurrent metformin prescription with HbA1c ≥1.5% above goal, or contraindication to metformin
  • Confirmation patient is not currently on a DPP-4 inhibitor
  • Documentation that preferred PDL drug was tried or reason for non-preferred PA criteria

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 2mg — Max 2 mg SQ once weekly

Approval and renewal

  • Initial approval: 6 months
  • Renewal: Improvement in A1C.
  • Renewal: Renewal requires either: (1) reduction of HbA1c of at least 1% since the last approval, OR (2) achievement or maintenance of therapeutic HbA1c goal as specified on the initial request. Renewal duration is 12 months if at HbA1c goal, or 6 months if not at goal but at least 1% further reduction since last approval. Age and dosing limits must still be met.

Not covered when

  • Concurrent DPP-4 inhibitor use
  • Type 1 diabetes

Policy note: This is a Kansas Medicaid (KMAP) PA policy. The document references preferred PDL drugs; non-preferred PDL criteria may apply separately. For HbA1c >10% or glucose ≥300 mg/dL, injectable therapy (GLP-1 RA or basal insulin) is recommended but not required. Maximum dose per Table 1 is 2 mg SQ once weekly. The document covers semaglutide injection (Ozempic) under the GLP-1 RA section for glycemic control. Rybelsus (oral semaglutide) is covered under a separate entry.

Policy effective April 16, 2025 · verified June 4, 2026 · source: Diabetes Mellitus Type 2 Agents Pdf · View policy document (PDF)

Open on its own page →

Full requirements: Ozempic for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Risk reduction of major CV events with T2DM and established CV disease

All of:

  • Diagnosis of T2DM
  • Age ≥ 18 years
  • Dose does not exceed 2 mg SQ once weekly
  • Patient is not currently on a DPP-4 inhibitor
  • Preferred PDL drug trial completed unless non-preferred PDL PA criteria met

Plus any one of:

  • History of coronary heart disease
  • History of cerebrovascular disease (stroke or TIA)
  • History of peripheral arterial disease
  • History of acute coronary syndrome (MI or unstable angina)
  • History of arterial revascularization (e.g., CABG)

High risk of developing ASCVD (alternative to established ASCVD)

All of:

  • Diagnosis of T2DM
  • Age ≥ 18 years
  • Dose does not exceed 2 mg SQ once weekly
  • Patient is not currently on a DPP-4 inhibitor
  • Preferred PDL drug trial completed unless non-preferred PDL PA criteria met

Plus any one of:

  • Age ≥ 55 years with coronary, carotid, or lower extremity artery stenosis >50%
  • Left ventricular hypertrophy (LVH)
  • 10-year ASCVD risk ≥ 15%
  • Diagnosis of heart failure
  • Diagnosis of chronic kidney disease

Documentation to bring

  • Diagnosis of T2DM
  • Documentation of established ASCVD (coronary heart disease, cerebrovascular disease, PAD, ACS, or arterial revascularization) OR qualifying high-risk criteria (age ≥55 with >50% stenosis, LVH, 10-year ASCVD risk ≥15%, CKD, or heart failure)
  • Confirmation patient is not currently on a DPP-4 inhibitor
  • Documentation that preferred PDL drug was tried or reason for non-preferred PA criteria

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 2mg — Max 2 mg SQ once weekly

Approval and renewal

  • Renewal: No renewal required for CV risk reduction indication (indefinite initial approval).

Not covered when

  • Concurrent DPP-4 inhibitor use
  • Type 1 diabetes

Policy note: Approval for CV risk reduction is indefinite (no renewal required) per the policy. T2DM is required for this CV indication (this is the Ozempic SUSTAIN-6/CVOT indication requiring established T2DM with CV disease, not the Wegovy non-diabetic CV indication). The document groups CV and CKD indications together under 'risk reduction in related comorbidities' with the same qualifying criteria.

Policy effective April 16, 2025 · verified June 4, 2026 · source: Diabetes Mellitus Type 2 Agents Pdf · View policy document (PDF)

Open on its own page →

Full requirements: Ozempic for Kidney Disease (CKD) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Risk reduction for CKD with T2DM

All of:

  • Diagnosis of T2DM
  • Diagnosis of chronic kidney disease
  • Age ≥ 18 years
  • Dose does not exceed 2 mg SQ once weekly
  • Patient is not currently on a DPP-4 inhibitor
  • Preferred PDL drug trial completed unless non-preferred PDL PA criteria met

Documentation to bring

  • Diagnosis of T2DM
  • Diagnosis of chronic kidney disease
  • Confirmation patient is not currently on a DPP-4 inhibitor
  • Documentation that preferred PDL drug was tried or reason for non-preferred PA criteria

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 2mg — Max 2 mg SQ once weekly

Approval and renewal

  • Renewal: No renewal required for CKD risk reduction indication (indefinite initial approval).

Not covered when

  • Concurrent DPP-4 inhibitor use
  • Type 1 diabetes

Policy note: Table 1 specifically lists the CKD indication for Ozempic as: 'Risk reduction of sustained eGFR decline, end-stage kidney disease and CV death in adults with T2DM and chronic kidney disease.' Approval is indefinite (no renewal required). The document does not specify minimum eGFR or UACR thresholds for the CKD indication; criteria are per FDA label.

Policy effective April 16, 2025 · verified June 4, 2026 · source: Diabetes Mellitus Type 2 Agents Pdf · View policy document (PDF)

Open on its own page →

Questions people ask
Does Kansas Medicaid cover Ozempic?
Yes. Kansas Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Kansas Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months.
What does Kansas Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Renewal requires either: (1) reduction of HbA1c of at least 1% since the last approval, OR (2) achievement or maintenance of therapeutic HbA1c goal as specified on the initial request. Renewal duration is 12 months if at HbA1c goal, or 6 months if not at goal but at least 1% further reduction since last approval. Age and dosing limits must still be met. Heart Disease Risk Reduction — Applies to Medicaid plans. No renewal required for CV risk reduction indication (indefinite initial approval). Kidney Disease (CKD) — Applies to Medicaid plans. No renewal required for CKD risk reduction indication (indefinite initial approval).
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 Kansas Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: BCBS Kansas, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

Summary of Kansas Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.