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Kentucky Medicaid

Does Kentucky Medicaid cover Ozempic for Type 2 Diabetes?

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

Policy document

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review July 7, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes

All of:

  • ICD-10 diagnosis of T2DM confirmed in chart notes within the past 12 months
  • A1C lab value ≥ 6.5% (current within past 6 months, OR historical ≥ 6.5% PLUS current A1C within past 6 months)
  • No personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Not used in combination with another GLP-1 receptor agonist OR DPP-4 inhibitor (unless member is changing therapy)
  • Requested dose does not exceed maximum FDA-approved dose for treatment of diabetes mellitus

Documentation to bring

  • ICD-10 diagnosis of T2DM in chart notes within the past 12 months
  • A1C lab value ≥ 6.5% (current within past 6 months; OR historical ≥ 6.5% PLUS current A1C within past 6 months)
  • Attestation of no personal or family history of MTC or MEN 2
  • Attestation that drug will not be combined with another GLP-1 or DPP-4 inhibitor (unless changing therapy)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Improvement in A1C.
  • Renewal: At renewal: ICD-10 diagnosis of T2DM (chart notes within past 12 months); A1C value within past 6 months; provider attestation of positive response to therapy (safety and efficacy); no personal/family history of MTC or MEN 2; not used in combination with another GLP-1 or DPP-4 (unless changing therapy); dose does not exceed maximum FDA-approved dose for diabetes.

Not covered when

  • Drugs used for anorexia, weight loss, or weight gain are excluded from coverage under this benefit

Policy note: Ozempic is a Preferred agent (Preferred with PA). Shares identical criteria with Mounjaro, Trulicity, and Victoza in the preferred GLP-1 tier. GLP-1 medications are limited to two brand switches per year. The weight loss/anorexia exclusion footnote applies.

Policy effective July 1, 2026 · verified July 7, 2026 · source: Kentucky Medicaid PA Criteria · View policy document (PDF)

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Questions people ask
Does Kentucky Medicaid cover Ozempic?
Yes. Kentucky 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 Kentucky Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Kentucky Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. At renewal: ICD-10 diagnosis of T2DM (chart notes within past 12 months); A1C value within past 6 months; provider attestation of positive response to therapy (safety and efficacy); no personal/family history of MTC or MEN 2; not used in combination with another GLP-1 or DPP-4 (unless changing therapy); dose does not exceed maximum FDA-approved dose for diabetes.
How current is this information?
The oldest review date among the policies on this page is July 7, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Kentucky Medicaid: Mounjaro, Wegovy, Zepbound

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

All insurance plans · All medications

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