Maryland Medicaid

Does Maryland Medicaid cover Wegovy?

Quick answer · Heart Disease Risk Reduction

Maryland Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. BMI of 27 or higher

Last verified June 4, 2026. Source: policy-368.html. How we verify this data →

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Wegovy for Heart Disease Risk Reduction

What Maryland Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What 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

Wegovy for Liver Disease (MASH)

What Maryland Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by liver_biopsy and non_invasive_testing_per_appendix, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH Initial Approval

All of:

  • Age >= 18 years
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Diagnosis of noncirrhotic MASH with liver fibrosis stage F2 or F3 confirmed by liver biopsy or acceptable non-invasive testing method (per Appendix) within the last 180 days
  • No chronic liver disease other than noncirrhotic MASH (excludes alcoholic liver disease, autoimmune hepatitis, viral hepatitis, Wilson's disease, etc.)
  • No presence of liver cirrhosis or history of decompensated liver disease
  • No history of liver transplantation or current/prior hepatocellular carcinoma
  • Alcohol consumption does not exceed 20 g/day for females or 30 g/day for males
  • No concurrent use of another medication indicated for noncirrhotic MASH
  • 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

Documentation to bring

  • Prescription from or documentation of consultation with a gastroenterologist or hepatologist
  • Liver biopsy or acceptable non-invasive fibrosis test result (per Appendix) within the last 180 days confirming noncirrhotic MASH with fibrosis stage F2 or F3
  • Documentation confirming absence of other chronic liver diseases (alcoholic liver disease, autoimmune hepatitis, viral hepatitis, Wilson's disease, etc.)
  • Documentation confirming no liver cirrhosis or history of decompensated liver disease
  • Documentation confirming no history of liver transplantation or current/prior hepatocellular carcinoma
  • Documentation confirming alcohol consumption does not exceed 20 g/day (female) or 30 g/day (male)
  • Confirmation of no concurrent use of another medication indicated for noncirrhotic MASH
  • 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 Prescriber attests to continued clinical benefit and subsequent evaluation and monitoring performed.

Not covered when

  • Chronic liver disease other than noncirrhotic MASH (alcoholic liver disease, autoimmune hepatitis, viral hepatitis, Wilson's disease, etc.)
  • Presence of liver cirrhosis or history of decompensated liver disease
  • History of liver transplantation or current/prior hepatocellular carcinoma
  • Excessive alcohol consumption (> 20 g/day for females; > 30 g/day for males)
  • Concurrent use of another medication indicated for noncirrhotic MASH
  • Concurrent use of other semaglutide-containing products or GLP-1 receptor agonists

Policy note: Fibrosis confirmation must be within the last 180 days (6 months) via liver biopsy or non-invasive testing methods listed in the Appendix (not reproduced in this document — a separate link is referenced for acceptable fibrosis tests). Fibrosis stages F2 to F3 are required (F4/cirrhosis is excluded). The lookback period of 6 months is applied uniformly to all confirmation methods as stated in the policy text ('within the last 180 days'). The Appendix defining acceptable non-invasive fibrosis tests was not included in the provided document text.

verified June 4, 2026 · source: policy-368.html

Why Wegovy requests get denied by Maryland Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Prescriber isn't the specialist the plan requires.

Frequently asked questions

Does Maryland Medicaid cover Wegovy?
Maryland Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.
What BMI do you need for Wegovy under Maryland Medicaid?
For heart disease risk reduction on Medicaid plans, Maryland Medicaid requires a BMI of 27 or higher.
How long does a Wegovy approval last with Maryland Medicaid?
Initial approvals last 4 months, and renewals are granted in 6-month periods.
What does Maryland Medicaid require to renew Wegovy?
Continued weight reduction or maintenance must be documented. Renewal will NOT be authorized if BMI <= 24 kg/m2.
How current is this information?
This page reflects Maryland Medicaid's written policy as of its current version, last verified against the source document on June 4, 2026.

Other medications under Maryland Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Maryland Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.