Skip to content

Kentucky Medicaid

Does Kentucky Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. Kentucky Medicaid covers Wegovy for liver disease (MASH) with prior authorization. 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 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 liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Kentucky Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Kentucky Medicaid require to renew Wegovy?
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.