Medicaid
Covered with requirementsWhat 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