Kansas Medicaid

Does Kansas Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

Kansas Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. Trial of metformin for at least 90 days, or a documented reason it can't be used (["contraindication", "combination_with_high_a1c"])

Last verified June 4, 2026. Policy effective April 16, 2025. Source: Diabetes-Mellitus-Type-2-Agents-PDF. How we verify this data →

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Ozempic for Type 2 Diabetes

What Kansas Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Trial of metformin for at least 90 days, or a documented reason it can't be used (["contraindication", "combination_with_high_a1c"])
  • Lab results confirming eligibility

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
  • To renew, the plan looks for improvement in A1C and 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

Ozempic for Heart Disease Risk Reduction

What Kansas Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Established cardiovascular disease (coronary_heart_disease, cerebrovascular_disease, stroke, TIA, PAD, MI, unstable_angina, arterial_revascularization, and CABG)

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

  • To renew, the plan looks for 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

Ozempic for Kidney Disease (CKD)

What Kansas Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older

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

  • To renew, the plan looks for 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

Why Ozempic requests get denied by Kansas Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.
  2. No documented metformin trial (dose, dates, and outcome) or a stated reason it can't be used.

Frequently asked questions

Does Kansas Medicaid cover Ozempic?
Kansas Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
Do you have to try metformin before Ozempic?
Yes for type 2 diabetes: Kansas Medicaid requires a documented trial of metformin of at least 90 days, or a documented reason it can't be used (["contraindication", "combination_with_high_a1c"]).
How long does a Ozempic approval last with Kansas Medicaid?
Initial approvals last 6 months.
What does Kansas Medicaid require to renew Ozempic?
Improvement in A1C and 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.
How current is this information?
This page reflects Kansas Medicaid's written policy as of April 16, 2025, last verified against the source document on June 4, 2026.

Other medications under Kansas Medicaid

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Kansas Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.