Maryland Medicaid coverage for Wegovy (Liver Disease (MASH))

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.

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