Michigan Medicaid

Does Michigan Medicaid cover Wegovy?

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Quick answer · Weight Loss

Michigan Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. BMI of 40 or higher

Last verified June 4, 2026. Policy effective July 1, 2026. Source: MIRx_clinical_criteria.pdf. How we verify this data →

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Wegovy for Weight Loss

What Michigan Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 12 and older
  • BMI of 40 or higher
  • Prior trial of benzphetamine, diethylpropion, orlistat, phendimetrazine, and phentermine

Qualification pathways

You can qualify through any one of these.

Step therapy: allergy, contraindication, DDI, side effects, or trial-and-failure of all five preferred agent types

Plus any one of:

  • Allergy to all five types of preferred medications (benzphetamine, diethylpropion, orlistat, phendimetrazine, phentermine)
  • Contraindication or drug-to-drug interaction with all five types of preferred medications
  • History of unacceptable side effects with all five types of preferred medications
  • Trial and failure with all five types of preferred agents (at least one orlistat agent, one phentermine product, plus benzphetamine, diethylpropion, and phendimetrazine)

Initial approval — additional medication-specific criteria (all required)

All of:

  • Prescriber attests patient will not use more than one weight loss medication in this drug class concurrently
  • Prescriber attests documented failure of all other clinically appropriate weight loss interventions
  • Prescriber attests use of GLP-1 for weight loss is to avert the need for higher-cost bariatric surgery
  • Prescriber attests patient will not use an anti-obesity GLP-1 agonist concurrently with a DPP-4 inhibitor (alogliptin, linagliptin, saxagliptin, or sitagliptin)
  • Prescriber attests to absence of contraindications including pregnancy, lactation, personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type II
  • Prescriber attests medication therapy is part of a total treatment plan including diet and exercise/activity
  • Prescriber attests patient has been informed weight may return with cessation unless lifestyle changes are permanently adopted
  • Prescriber attests metabolic or other reasons for obesity/symptoms have been ruled out or diagnosed and treated (e.g., thyroid dysfunction, diabetes, sleep apnea)
  • For patients with an eating disorder: prescriber attests treatment has been optimized and confirms safety and appropriateness

Plus any one of:

  • Patient age ≥12 years (Wegovy): prescriber attests patient age 12 to <18 years with initial BMI classified as morbidly obese per CDC growth charts for age and sex
  • Patient age ≥18 years with initial BMI classified as morbidly obese (BMI ≥40 kg/m²)

Documentation to bring

  • Prescriber attestation that patient will not use more than one weight loss medication in this drug class concurrently
  • Prescriber attestation of documented failure of all other clinically appropriate weight loss interventions
  • Prescriber attestation that use of GLP-1 is to avert the need for higher-cost bariatric surgery
  • Prescriber attestation that patient will not use an anti-obesity GLP-1 agonist concurrently with a DPP-4 inhibitor
  • Prescriber attestation of absence of contraindications (pregnancy, lactation, personal or family history of medullary thyroid cancer or MEN2)
  • Prescriber attestation that medication is part of a total treatment plan including diet and exercise
  • Prescriber attestation that patient has been informed about weight return upon cessation
  • Prescriber attestation that metabolic or other causes of obesity have been ruled out or treated
  • For patients with eating disorder: prescriber attestation that treatment has been optimized
  • Documentation of step therapy: allergy, contraindication, DDI, unacceptable side effects, or trial-and-failure of all five preferred agent types (benzphetamine, diethylpropion, orlistat, phendimetrazine, phentermine)
  • For patients age 12–<18: prescriber attestation of morbid obesity per CDC BMI growth charts
  • For patients ≥18: baseline BMI documentation (≥40 kg/m²)
  • Renewal — patients ≥18: clinical documentation of weight at renewal showing ≥5% weight loss from baseline
  • Renewal — patients 12–<18: clinical documentation of BMI percentile at renewal showing maintained or improved BMI percentile per CDC growth charts from baseline

Quantity limits

  • 0.25 mg/0.5 mL — 2 mL (4 pens) per 28 days
  • 0.50 mg/0.5 mL — 2 mL (4 pens) per 28 days
  • 1 mg/0.5 mL — 2 mL (4 pens) per 28 days
  • 1.7 mg/0.75 mL — 3 mL (4 pens) per 28 days
  • 2.4 mg/0.75 mL — 3 mL (4 pens) per 28 days

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight and For patients ≥18 years: must have maintained weight loss of ≥5% from baseline weight at initiation of therapy. For patients 12 to <18 years: prescriber must provide clinical documentation showing the patient has maintained or improved BMI percentile per CDC growth charts from baseline. For 1st renewal of established members with initial approval prior to 1/1/2026: prescriber attests to morbid obesity at start, documented failure of all other weight loss interventions, and use was to avert bariatric surgery, plus same weight/BMI maintenance requirements. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • Lactation
  • Personal or family history of medullary thyroid cancer
  • Personal or family history of multiple endocrine neoplasia type II
  • Concurrent use of a DPP-4 inhibitor (alogliptin, linagliptin, saxagliptin, sitagliptin)
  • Concurrent use of another anti-obesity GLP-1 agonist
  • Pregnancy

Policy note: This policy applies to 'non-preferred GLP-1s only' for weight loss under Michigan Medicaid PDL. Wegovy (semaglutide) age minimum is 12 years. 'Wegovy HD' (semaglutide 7.2 mg/0.75 mL) is listed separately in quantity limits with the same 3 mL (4 pens) per 28 days limit and has a minimum age of 18. MDHHS recommends prescribers consider the benefits of a diabetes prevention program. A special 1st renewal pathway exists for established members with initial approval prior to 1/1/2026 that requires attestation of morbid obesity at start, documented failure of other interventions, and use to avert bariatric surgery, plus the standard weight/BMI maintenance criteria. The morbidly obese BMI threshold for adults is ≥40 kg/m²; for pediatric patients (12–<18), morbid obesity is per CDC growth charts (no absolute BMI stated).

Policy effective July 1, 2026 · verified June 4, 2026 · source: MIRx_clinical_criteria.pdf

Wegovy for Liver Disease (MASH)

What Michigan Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 27 or higher
  • Confirmed MASH diagnosis, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Initial Approval — Wegovy for MASH

All of:

  • Prescriber attests patient will not use Wegovy concurrently with another GLP-1 agonist
  • Prescriber attests patient will not use Wegovy concurrently with a non-GLP-1 weight loss medication
  • Prescriber attests patient will not use Wegovy concurrently with a DPP-4 inhibitor (alogliptin, linagliptin, saxagliptin, or sitagliptin)
  • Patient >= 18 years of age
  • Prescriber attests patient has initial BMI >= 27 kg/m²
  • Prescriber attests patient has noncirrhotic MASH (formerly NASH) with moderate to advanced liver fibrosis (F2 to F3)
  • For patients with an eating disorder: prescriber attests treatment has been optimized and confirms safety and appropriateness
  • Prescriber attests metabolic or other reasons for obesity/symptoms have been ruled out or diagnosed and treated (e.g., thyroid dysfunction, diabetes, sleep apnea)
  • Prescriber attests absence of contraindications including pregnancy, lactation, personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type II
  • Prescriber attests medication is part of a total treatment plan including diet and exercise/activity as appropriate
  • Prescriber attests patient has been informed weight may return upon cessation unless lifestyle changes are permanently adopted

Renewal Approval — Wegovy for MASH

All of:

  • Prescriber attests patient is currently established on the medication
  • Prescriber attests patient continues to have noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3)
  • Clinical documentation demonstrating patient has maintained >= 5% weight loss from baseline weight at initiation of therapy

Documentation to bring

  • Prescriber attestation that patient will not use Wegovy concurrently with another GLP-1 agonist
  • Prescriber attestation that patient will not use Wegovy concurrently with a non-GLP-1 weight loss medication
  • Prescriber attestation that patient will not use Wegovy concurrently with a DPP-4 inhibitor
  • Documentation of patient age >= 18 years
  • Baseline BMI documentation (>= 27 kg/m²)
  • Prescriber attestation of noncirrhotic MASH diagnosis with moderate to advanced fibrosis (F2 to F3)
  • Prescriber attestation regarding eating disorder status (if applicable: treatment optimized and safety confirmed)
  • Prescriber attestation that metabolic/other causes of obesity have been ruled out or treated
  • Prescriber attestation of absence of contraindications (pregnancy, lactation, personal/family history of medullary thyroid cancer or MEN2)
  • Prescriber attestation that medication is part of a total treatment plan including diet and exercise
  • Prescriber attestation that patient has been counseled on weight regain risk upon cessation
  • [Renewal] Clinical documentation of current weight showing >= 5% weight loss from baseline

Quantity limits

  • 0.25 mg/0.5 mL, 0.50 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (4 pens) per 28 days
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (4 pens) per 28 days

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight and Patient must have maintained a weight loss of >= 5% from baseline weight at initiation of therapy. Prescriber must also attest that patient is currently established on the medication and continues to have noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3). Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • Lactation
  • Personal or family history of medullary thyroid cancer
  • Multiple endocrine neoplasia type II (MEN2)
  • Concurrent use of another GLP-1 agonist
  • Concurrent use of a non-GLP-1 weight loss medication
  • Concurrent use of a DPP-4 inhibitor (alogliptin, linagliptin, saxagliptin, or sitagliptin)
  • Pregnancy

Policy note: This policy is specific to Michigan Medicaid and is managed by Prime Therapeutics. The document covers Wegovy ONLY for the MASH indication. No fibrosis confirmation method (e.g., FIB-4, FibroScan, biopsy) is specified — only a prescriber attestation of noncirrhotic MASH with F2-F3 fibrosis is required. The policy does not require cirrhosis to be absent per a specific test but does specify 'noncirrhotic.' MDHHS recommends (but does not require) a diabetes prevention program. The renewal requires documentation of >= 5% weight loss from baseline but does not re-verify all initial criteria (e.g., BMI threshold and concurrent medication restrictions are framed as initial attestations).

Policy effective July 1, 2026 · verified June 4, 2026 · source: MIRx_clinical_criteria.pdf

Why Wegovy requests get denied by Michigan Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Required prior medication trials not documented.
  4. Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Michigan Medicaid cover Wegovy?
Michigan Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.
What BMI do you need for Wegovy under Michigan Medicaid?
For weight loss on Medicaid plans, Michigan Medicaid requires a BMI of 40 or higher.
How long does a Wegovy approval last with Michigan Medicaid?
Initial approvals last 6 months, and renewals are granted in 6-month periods.
What does Michigan Medicaid require to renew Wegovy?
At least 5% weight loss from the starting weight and For patients ≥18 years: must have maintained weight loss of ≥5% from baseline weight at initiation of therapy. For patients 12 to <18 years: prescriber must provide clinical documentation showing the patient has maintained or improved BMI percentile per CDC growth charts from baseline. For 1st renewal of established members with initial approval prior to 1/1/2026: prescriber attests to morbid obesity at start, documented failure of all other weight loss interventions, and use was to avert bariatric surgery, plus same weight/BMI maintenance requirements.
How current is this information?
This page reflects Michigan Medicaid's written policy as of July 1, 2026, last verified against the source document on June 4, 2026.

Other medications under Michigan Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Michigan Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.