Medicaid
Covered with requirementsNo additional clinical requirements are listed beyond the diagnosis.
Qualification pathways
You can qualify through any one of these.
Preferred Agent Criteria
All of:
- Diagnosis of type 2 diabetes
- Discontinuation of other GLP-1 agonists
- Discontinuation of DPP-4 inhibitors
Non-Preferred Agent Criteria
All of:
- Diagnosis of type 2 diabetes
- Discontinuation of other GLP-1 agonists
- Discontinuation of DPP-4 inhibitors
Plus any one of:
- Allergy to the preferred medications
- Contraindication or drug-to-drug interaction with the preferred medications
- History of unacceptable side effects
- Trial and failure with one preferred medication within same subgroup
Documentation to bring
- Documentation of type 2 diabetes diagnosis
- Documentation of discontinuation of other GLP-1 agonists
- Documentation of discontinuation of DPP-4 inhibitors
- If non-preferred: documentation of allergy, contraindication, drug interaction, unacceptable side effects, or trial and failure with a preferred agent in the same subgroup
Quantity limits
- all strengths — 3 pens per 84 days (84-day)
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
Policy note: Ozempic is listed in the Michigan Medicaid PDL under 'Diabetes: Incretin Mimetics and Combinations'. Preferred vs. non-preferred status is determined by the Michigan Preferred Drug List (PDL), which is referenced but not fully reproduced in this document. The criteria apply to the PDL class broadly. The 'discontinuation of other GLP-1 agonists' criterion means the patient must not be on another GLP-1 concurrently.
Policy effective July 1, 2026 · verified June 4, 2026 · source: MIRx_clinical_criteria.pdf