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Maryland Medicaid

Does Maryland Medicaid cover Wegovy?

Yes. Maryland 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/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
  • Renewal: 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 · View policy document (PDF)

Open on its own page →

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.

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
  • Renewal: 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 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Maryland Medicaid cover Wegovy?
Yes. Maryland 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 Maryland Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 4 months. Renewal: every 6 months. Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 4 months. Renewal: every 6 months.
What does Maryland Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Continued weight reduction or maintenance must be documented. Renewal will NOT be authorized if BMI ≤ 24 kg/m2. Liver Disease (MASH) — Applies to Medicaid plans. Prescriber attests to continued clinical benefit and subsequent evaluation and monitoring performed.
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 Maryland Medicaid: Zepbound

Wegovy under other plans: Kaiser Permanente Mid-Atlantic, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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