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Massachusetts Medicaid

Does Massachusetts Medicaid cover Ozempic for Kidney Disease (CKD)?

Yes. Massachusetts Medicaid covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Massachusetts

Full requirements: Ozempic for Kidney Disease (CKD) (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Ozempic for T2DM and CKD

All of:

  • Appropriate diagnosis of type 2 diabetes and chronic kidney disease
  • eGFR ≤ 75 mL/min/1.73 m² dated within last 90 days
  • Inadequate response or adverse reaction to one, or contraindication to both, of dapagliflozin and Jardiance
  • Requested agent will not be used in combination with another GLP-1 receptor agonist
  • If quantity exceeds limits: clinical rationale provided

Plus any one of:

  • For eGFR ≥ 50: UACR > 300 and < 5,000 mg/g
  • For eGFR < 50: UACR > 100 and < 5,000 mg/g

ACE-I/ARB requirement for CKD indication

Plus any one of:

  • Requested agent will be used in combination with an ACE-I or ARB
  • Adverse reaction to one ACE-I or ARB
  • Contraindication to use of all ACE-Is and ARBs

Documentation to bring

  • Appropriate diagnosis of type 2 diabetes and chronic kidney disease
  • eGFR lab result (≤ 75 mL/min/1.73 m²) dated within last 90 days
  • Urinary albumin-to-creatinine ratio (UACR) lab result: > 300 and < 5,000 mg/g if eGFR ≥ 50, OR > 100 and < 5,000 mg/g if eGFR < 50
  • Documentation of current ACE-I or ARB use, OR adverse reaction to one ACE-I or ARB, OR contraindication to all ACE-Is and ARBs
  • Documentation of inadequate response or adverse reaction to dapagliflozin or Jardiance, or contraindication to both
  • Attestation that requested agent will not be used in combination with another GLP-1 receptor agonist
  • If quantity exceeds limits: clinical rationale why dose cannot be consolidated or for exceeding FDA-approved dosing

Quantity limits

  • all strengths — 1 prefilled pen per 28-day supply

Not covered when

  • Combination use with another GLP-1 receptor agonist is prohibited
  • UACR ≥ 5,000 mg/g excludes coverage
  • eGFR > 75 excludes coverage

Policy note: The CKD indication requires T2DM as a co-diagnosis. eGFR must be ≤ 75 mL/min/1.73 m². UACR threshold differs based on eGFR: for eGFR ≥ 50, UACR must be > 300 and < 5,000 mg/g; for eGFR < 50, UACR must be > 100 and < 5,000 mg/g. SGLT2 inhibitor step therapy (dapagliflozin and Jardiance) required. ACE-I/ARB use required or exception documented. This is listed as an FDA-approved indication: 'Type 2 diabetes mellitus and chronic kidney disease (Ozempic)' in the document.

verified June 4, 2026 · source: Policy 348 · View policy document (PDF)

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Questions people ask
Does Massachusetts Medicaid cover Ozempic?
Yes. Massachusetts Medicaid covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.
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.

Card and program names on file in Massachusetts

These names map to Massachusetts Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Massachusetts Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: BCBS Massachusetts, Fallon Health Plan, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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