Does Massachusetts Medicaid cover Wegovy for Liver Disease (MASH)?

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• Documentation of appropriate diagnosis (NASH or MASH)
• Medical records from liver biopsy OR noninvasive testing (NIT) confirming moderate to advanced liver fibrosis (stages F2 to F3)
• Documentation that member is ≥ 18 years of age
• Prescriber is a gastroenterologist or hepatologist OR consult notes from a gastroenterologist or hepatologist
• Documentation that member has been counseled to continue reduced-calorie diet and increased physical activity
• Documentation that member has been counseled to limit alcohol use
• Attestation that requested agent will not be used in combination with another GLP-1 receptor agonist
• Requested quantity ≤ 4 pens/28 days
• If combination with Rezdiffra: documentation of inadequate response to Rezdiffra monotherapy for ≥ 1 year AND Wegovy 2.4 mg for ≥ 6 months, OR documentation of stable combination therapy
• For recertification: laboratory or imaging testing documenting positive response to therapy

Quantity limits

• all injection strengths — 4 pens per 28 days

Approval and renewal

• Renewal: For recertification: documentation of laboratory or imaging testing that indicates a positive response to therapy is required.

Not covered when

• Cirrhotic MASH is not covered under this indication (noncirrhotic MASH only for the weight loss pathway; the MASH-specific pathway does not explicitly state noncirrhotic but requires F2-F3 fibrosis)
• Combination use with another GLP-1 receptor agonist is not permitted
• Combination with Rezdiffra requires either inadequate response to both monotherapies or documentation of stable existing combination therapy

Policy note: MassHealth (Massachusetts Medicaid) policy. This is a separate, distinct indication pathway for Wegovy injection (not tablet) specifically for NASH/MASH with moderate to advanced liver fibrosis (F2-F3). The policy uses both 'NASH' and 'MASH' terminology. Noninvasive testing (NIT) is accepted alongside liver biopsy — specific NIT methods are not enumerated (policy says 'liver biopsy or noninvasive testing (NIT)'). A gastroenterologist or hepatologist prescriber or consult is required. Rezdiffra (resmetirom) combination therapy is specifically addressed with pathways for monotherapy, inadequate response to prior combination, and stable combination therapy. Recertification requires lab or imaging evidence of positive response. Last revised 05/2026.

Policy effective January 1, 2024 · verified June 4, 2026 · source: Massachusetts Medicaid Medicaid prior authorization policy · View policy document (PDF)