Massachusetts Medicaid coverage for Ozempic (Kidney Disease (CKD))

What you need to qualify

• On guideline-directed medical therapy (ACE_inhibitor and ARB)
• eGFR no higher than 75
• Urine albumin-to-creatinine ratio of 100 or higher
• Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

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.html