Maryland Medicaid coverage for Wegovy (Heart

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

Maryland Medicaid coverage for Wegovy (Heart Disease Risk Reduction)