Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 27 or higher
- Prescribed by or in consultation with a specialist
- Established cardiovascular disease (MI, stroke, PAD, peripheral_arterial_revascularization, and amputation_due_to_atherosclerotic_disease)
Qualification pathways
You can qualify through any one of these.
MACE/CV Risk Reduction Initial Approval
All of:
- Age >= 18 years
- BMI >= 27 kg/m2
- Current accurate height and weight measurements within the last 90 days
- Established ASCVD (history of prior MI, and/or prior stroke, and/or symptomatic peripheral arterial disease)
- Prescribed by or in consultation with a cardiologist
- Co-administration with other semaglutide-containing products or GLP-1 receptor agonists is not occurring
- Prescriber attests medication is prescribed in accordance with prescribing information including screening for black box warnings and contraindications
Plus any one of:
- Prior myocardial infarction
- Prior stroke
- Symptomatic peripheral arterial disease (intermittent claudication with ABI < 0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease)
Documentation to bring
- Prescription from or documentation of consultation with a cardiologist
- Current accurate height and weight measurements within the last 90 days confirming BMI >= 27 kg/m2
- Documentation of established ASCVD (prior MI, prior stroke, or symptomatic peripheral arterial disease with ABI < 0.85, revascularization, or amputation due to atherosclerotic disease)
- Prescriber attestation that medication is prescribed in accordance with prescribing information, including screening for black box warnings and all contraindications
- Confirmation of no concurrent use of other semaglutide-containing products or GLP-1 receptor agonists
Quantity limits
- any strength — 4 pens/28 days
Approval and renewal
- Initial approval: 4 months
- Renewal: every 6 months
- To renew, the plan looks for Continued weight reduction or maintenance must be documented. Renewal will NOT be authorized if BMI <= 24 kg/m2.
Not covered when
- Concurrent use of other semaglutide-containing products
- Concurrent use of GLP-1 receptor agonists
- BMI <= 24 kg/m2 at renewal
Policy note: Symptomatic PAD qualifying criteria include: intermittent claudication with ABI < 0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease. Renewal will NOT be authorized if BMI <= 24 kg/m2 or if continued weight reduction/maintenance is not documented.
verified June 4, 2026 · source: policy-368.html