Medicaid
Covered with requirementsWhat 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