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Maryland Medicaid

Does Maryland Medicaid cover Wegovy for Heart Disease Risk Reduction?

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)

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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.
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.
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.