Medicaid
Covered with requirementsWhat you need to qualify
- A1C of 6.5% or higher
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
Initial Approval - Preferred GLP-1 Agent
All of:
- Recipient meets minimum age requirement per POS Edits
- Recipient has a diagnosis of type 2 diabetes mellitus
Plus any one of:
- A1C >= 6.5% obtained within the previous 6 months
- A1C < 6.5% obtained within previous 6 months AND history of A1C >= 6.5% AND established cardiovascular disease (prior MI, prior stroke [ischemic or hemorrhagic], or peripheral arterial disease)
Documentation to bring
- Diagnosis of type 2 diabetes mellitus
- A1C lab result obtained within the previous 6 months (>= 6.5%); OR A1C < 6.5% within 6 months plus documentation of historical A1C >= 6.5% plus documentation of established CVD (prior MI, prior stroke, or PAD)
- Minimum age verification per POS Edits
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
- To renew, the plan looks for Prescriber attests that recipient is established on the medication with evidence of a positive response to therapy. Subsequent approval criteria only used if recipient previously obtained initial approval.
Not covered when
- Type 1 diabetes
Policy note: Ozempic is specifically named as eligible for the lower A1C pathway (A1C < 6.5% with history of A1C >= 6.5%) when the recipient has established cardiovascular disease, alongside Trulicity and Victoza. If Ozempic is non-preferred on the PDL, additional step therapy through a preferred GLP-1 agent is required (failure, intolerance, contraindication, or no preferred product appropriate). Preferred vs. non-preferred status not specified in this document; see the Single PDL at ldh.la.gov for current status.
Policy effective November 15, 2024 · verified June 2, 2026 · source: MMA_and_POS_GLP_and_A1C_NOV_2024_10-11-24_Criteria.pdf