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Kentucky Medicaid

Does Kentucky Medicaid cover Wegovy?

Yes. Kentucky 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.

MACE Risk Reduction — Initial Approval

All of:

  • Patient age ≥ 45 years
  • Being prescribed for MACE risk reduction (cardiovascular death, non-fatal MI, or non-fatal stroke)
  • Documentation within the past year of pre-existing CV disease (prior MI, prior stroke, or symptomatic PAD)
  • BMI ≥ 27 kg/m²
  • Documentation that medication will be used with reduced calorie diet and increased physical activity
  • Optimization on specified lipid-lowering therapy (moderate-to-high intensity statin or PCSK9 inhibitor) per claims history AND documentation
  • No history of type 2 diabetes
  • Current A1C < 6.5%
  • No NYHA class IV heart failure
  • No end-stage kidney disease or dialysis
  • No plans to undergo coronary, carotid, or peripheral revascularization
  • No personal or family history of MTC or MEN2
  • Not pregnant, breastfeeding, or intending to become pregnant without highly effective contraception
  • Requested dose does not exceed maximum FDA-approved dose
  • Not used in combination with another GLP-1 or dual GLP-1/GIP receptor agonist

Plus any one of:

  • On beta-blocker
  • On RAS inhibitor (ACE-I, ARB, or ARNI)
  • On antiplatelet therapy (e.g., aspirin, clopidogrel)
  • Prescriber provides medical justification for why patient cannot use lipid-lowering therapies AND beta-blockers, RAS inhibitors, or antiplatelet therapies

Documentation to bring

  • Documentation (e.g., progress note) within the past year confirming pre-existing cardiovascular disease (prior MI, prior stroke, or symptomatic PAD with supporting evidence)
  • Claims history showing optimization on moderate-to-high intensity statin or PCSK9 inhibitor
  • Documentation of concurrent use of beta-blocker, RAS inhibitor (ACE-I/ARB/ARNI), or antiplatelet therapy; OR medical justification for why these cannot be used (with dates of trial if applicable)
  • Baseline BMI documentation (≥ 27 kg/m²)
  • Documentation that medication will be used with reduced calorie diet and increased physical activity
  • Current A1C lab result confirming < 6.5%
  • Attestation that patient does not have NYHA class IV heart failure, ESKD/dialysis, planned revascularization, personal/family history of MTC or MEN2

Quantity limits

  • all strengths — pen injector — 4 pens per 28 days
  • all strengths — tablet — 1 tablet per day

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Patient must have at least 5% reduction in baseline body weight OR provider documents assessment of lifestyle and diet interventions if weight loss goal not met. Patient must continue on cardiovascular disease therapy management. Exclusions (no T2DM history, A1C < 6.5%, no NYHA class IV HF, no ESKD/dialysis, no planned revascularization, no MTC/MEN2 history, no pregnancy/breastfeeding) are re-verified at renewal. No re-verification of age ≥45, BMI ≥27, or documentation of qualifying CV event at renewal.

Not covered when

  • History of type 2 diabetes
  • Current A1C ≥ 6.5%
  • NYHA class IV heart failure
  • End-stage kidney disease or dialysis
  • Plans to undergo coronary, carotid, or peripheral revascularization
  • Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Breastfeeding
  • Female of child-bearing potential not using highly effective contraception
  • Concurrent use of another GLP-1 or dual GLP-1/GIP receptor agonist
  • Pregnancy

Policy note: This is a Kentucky Medicaid PA policy administered by MedImpact. The CV qualifying events for PAD include: amputation due to atherosclerotic disease, history of peripheral arterial revascularization, or intermittent claudication with ABI < 0.85 at rest. For stroke, both ischemic and hemorrhagic qualify. GDMT requires optimization on lipid-lowering therapy (statin or PCSK9) as evidenced by claims history, PLUS at least one of: beta-blocker, RAS inhibitor, or antiplatelet; or medical justification for inability to use all three classes. Wegovy tablet is not mentioned as excluded for the CV indication (only excluded for MASH). Copyright 2025 MedImpact Healthcare Systems.

verified June 4, 2026 · source: Wegovy PA Criteria 1.3.2026 · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH — Initial Approval

All of:

  • Request is NOT for Wegovy tablet (injection formulation only)
  • Patient age ≥ 18 years
  • Diagnosis of MASH (also known as NASH) with moderate to advanced liver fibrosis (stages F2 to F3)
  • Prior trial of diet, exercise, and lifestyle modification; patient will continue if approved
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Prescriber attests patient does not have excessive alcohol consumption
  • No history of type 2 diabetes
  • No evidence of cirrhosis
  • No hepatic decompensation
  • No hepatocellular carcinoma (HCC)
  • Not pregnant, breastfeeding, or intending to become pregnant without highly effective contraception
  • Requested dose does not exceed maximum FDA-approved dose
  • Not used in combination with another GLP-1 or dual GLP-1/GIP receptor agonist

Plus any one of:

  • Liver biopsy within the last 3 years confirming F2-F3 fibrosis
  • FIB-4 index > 2.67 within the last 6 months
  • FIB-4 index 1.3 to 2.67 with sequential VCTE or ELF test within the last 6 months

Documentation to bring

  • Confirmation that request is for injectable Wegovy (not tablet formulation)
  • Documentation of MASH/NASH diagnosis with fibrosis stage F2 or F3, confirmed by one of: liver biopsy within past 3 years, FIB-4 index > 2.67 within past 6 months, or FIB-4 index 1.3–2.67 with VCTE or ELF test within past 6 months
  • Documentation of prior trial of diet, exercise, and lifestyle modification
  • Prescription from or documentation of consultation with a gastroenterologist or hepatologist
  • Prescriber attestation that patient does not have excessive alcohol consumption
  • Attestation that patient does not have history of type 2 diabetes, cirrhosis, hepatic decompensation, or HCC

Quantity limits

  • all strengths — pen injector — 4 pens per 28 days

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Prescriber must submit clinical documentation of clinical benefit compared to baseline, confirmed by at least one of: liver biopsy improvement, reduction in steatohepatitis (NAS score reduction), reduction in liver fibrosis (NASH CRN fibrosis scale reduction), reduction in steatosis, reduction in lobular inflammation, or reduction in ballooning. Exclusions (no T2DM history, no cirrhosis, no hepatic decompensation, no HCC, no pregnancy/breastfeeding) are re-verified at renewal. MASH fibrosis confirmation (biopsy/FIB-4/VCTE/ELF) and specialist requirement are NOT re-verified at renewal.

Not covered when

  • Wegovy tablet formulation is not covered for MASH (injection only)
  • History of type 2 diabetes
  • Evidence of cirrhosis
  • Hepatic decompensation
  • Hepatocellular carcinoma (HCC)
  • Breastfeeding
  • Female of child-bearing potential not using highly effective contraception
  • Concurrent use of another GLP-1 or dual GLP-1/GIP receptor agonist
  • Excessive alcohol consumption
  • Pregnancy

Policy note: This is a Kentucky Medicaid PA policy administered by MedImpact. The MASH indication explicitly excludes the tablet formulation of Wegovy — injection only. Fibrosis confirmation pathways include: (1) liver biopsy within 3 years, (2) standalone FIB-4 > 2.67 within 6 months, or (3) FIB-4 1.3–2.67 combined with VCTE or ELF within 6 months. Specialist (gastroenterologist or hepatologist) prescribing or consultation is required. Alcohol limit is not quantified in grams — policy uses 'excessive alcohol consumption' without specifying a threshold. Copyright 2025 MedImpact Healthcare Systems.

verified June 4, 2026 · source: Wegovy PA Criteria 1.3.2026 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Kentucky Medicaid cover Wegovy?
Yes. Kentucky 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 Kentucky Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months. Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Kentucky Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Patient must have at least 5% reduction in baseline body weight OR provider documents assessment of lifestyle and diet interventions if weight loss goal not met. Patient must continue on cardiovascular disease therapy management. Exclusions (no T2DM history, A1C < 6.5%, no NYHA class IV HF, no ESKD/dialysis, no planned revascularization, no MTC/MEN2 history, no pregnancy/breastfeeding) are re-verified at renewal. No re-verification of age ≥45, BMI ≥27, or documentation of qualifying CV event at renewal. Liver Disease (MASH) — Applies to Medicaid plans. Prescriber must submit clinical documentation of clinical benefit compared to baseline, confirmed by at least one of: liver biopsy improvement, reduction in steatohepatitis (NAS score reduction), reduction in liver fibrosis (NASH CRN fibrosis scale reduction), reduction in steatosis, reduction in lobular inflammation, or reduction in ballooning. Exclusions (no T2DM history, no cirrhosis, no hepatic decompensation, no HCC, no pregnancy/breastfeeding) are re-verified at renewal. MASH fibrosis confirmation (biopsy/FIB-4/VCTE/ELF) and specialist requirement are NOT re-verified at renewal.
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 Kentucky Medicaid: Mounjaro, Ozempic, Zepbound

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

All insurance plans · All medications

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