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Kansas Medicaid

Does Kansas Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Kansas Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. 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: Wegovy 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.

CV Risk Reduction — Adults with Established CVD and No Diabetes

All of:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Established cardiovascular disease (history of myocardial infarction, stroke, or symptomatic peripheral arterial disease)
  • No history of Type 1 or Type 2 diabetes mellitus
  • Treatment plan includes comprehensive adjunct lifestyle interventions (diet modification, physical activity, behavioral therapy)
  • Prescriber provides baseline weight and BMI
  • Patient able to titrate and maintain therapeutic dose per FDA-approved labeling
  • Dose does not exceed 2.4 mg SC once weekly

Documentation to bring

  • Baseline weight and BMI documentation (BMI ≥ 27 kg/m2)
  • Documentation of established CVD (history of MI, stroke, or symptomatic PAD)
  • Documentation confirming no history of Type 1 or Type 2 diabetes mellitus
  • Documentation of comprehensive adjunct lifestyle intervention plan (diet, physical activity, behavioral therapy)

Quantity limits

  • 2.4 mg — Per FDA-approved dosing; dose not to exceed 2.4 mg SC once weekly

Approval and renewal

  • Renewal: every 6 months
  • Renewal: Continuation criteria for the CV risk reduction pathway are not separately specified beyond continued comprehensive adjunct lifestyle interventions. Table 4 high-cost agent renewal weight loss thresholds do NOT apply to Wegovy (as of 6/1/2025) and are explicitly excluded for this CVD pathway (Table 4 note states it does not apply to patients with baseline BMI ≥27 and established CVD requesting Wegovy).

Not covered when

  • Type 2 diabetes mellitus — patients with T2DM are explicitly excluded from this CV risk reduction pathway and must use the formulation indicated for T2DM
  • Professional samples may not be used to establish patient history of medication usage
  • Type 1 diabetes

Policy note: This CVD pathway is carved out from the Table 4 'high-cost' additional criteria (including severe obesity BMI ≥40 and 3-month lifestyle modification requirement) per explicit footnote in Table 4: 'does not apply to patients with baseline BMI ≥27 and established cardiovascular disease for adult patients requesting Wegovy.' Initial approval duration is 28 weeks (as of 6/1/2025). Established CVD is defined as history of myocardial infarction, stroke, or symptomatic peripheral arterial disease.

Policy effective August 14, 2024 · verified June 4, 2026 · source: Anti Obesity Medications Pdf · View policy document (PDF)

Open on its own page →

Questions people ask
Does Kansas Medicaid cover Wegovy?
Yes. Kansas Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Kansas Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Renewal: every 6 months.
What does Kansas Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Continuation criteria for the CV risk reduction pathway are not separately specified beyond continued comprehensive adjunct lifestyle interventions. Table 4 high-cost agent renewal weight loss thresholds do NOT apply to Wegovy (as of 6/1/2025) and are explicitly excluded for this CVD pathway (Table 4 note states it does not apply to patients with baseline BMI ≥27 and established CVD requesting Wegovy).
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, Ozempic, Zepbound

Wegovy under other plans: Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

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