Minnesota Medicaid

Does Minnesota Medicaid cover Wegovy?

Quick answer · Weight Loss

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

  • Medicaid: Covered with requirements. BMI of 30 or higher

Last verified June 4, 2026. Policy effective March 1, 2023. Source: policy-372.html. How we verify this data →

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Wegovy for Weight Loss

What Minnesota 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 30 or higher
  • BMI of 27 or higher with a weight-related condition (HTN, T2DM, and dyslipidemia)
  • BMI at or above the 30th percentile for age and sex

Qualification pathways

You can qualify through any one of these.

Initial Approval — Adult (>=18 years)

All of:

  • Patient meets age limit per FDA-approved label
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity unless medically contraindicated
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other weight loss drug(s)
  • Patient's weight at baseline (in kg) submitted at time of request

Plus any one of:

  • BMI >= 30 kg/m2 with no risk factors
  • BMI >= 27 kg/m2 with at least one weight-related comorbid condition (hypertension, T2DM, or dyslipidemia)

Initial Approval — Adolescent (12-17 years)

All of:

  • Patient meets age limit per FDA-approved label
  • BMI >= 30 kg/m2 AND body weight above 60 kg
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity unless medically contraindicated
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other weight loss drug(s)
  • Patient's weight at baseline (in kg) submitted at time of request

Renewal — Adult (>=18 years)

All of:

  • At least 5% weight loss during the initial approval period
  • Documentation of ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of ongoing regimen of increased physical activity unless medically contraindicated
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Renewal — Adolescent (12-17 years)

All of:

  • At least 5% reduction in baseline BMI during the initial approval period
  • Documentation of ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of ongoing regimen of increased physical activity unless medically contraindicated
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Subsequent Renewal (beyond 18 months)

All of:

  • Meets all standard renewal criteria
  • Documentation that patient maintains weight loss achieved during the initial approval period

Documentation to bring

  • Baseline BMI documentation (>=30 kg/m2 without comorbidity, or >=27 kg/m2 with at least one weight-related comorbidity for adults; >=30 kg/m2 and body weight >60 kg for ages 12-17)
  • Patient's baseline weight in kg
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity (or medical contraindication)
  • Documentation that no concurrent weight loss drugs are being used
  • At renewal: documentation of >=5% weight loss (adults) or >=5% BMI reduction (adolescents) during initial approval period
  • At subsequent renewals (beyond 18 months): documentation that weight loss achieved during initial approval period is maintained

Quantity limits

  • per FDA-approved label — Per FDA-approved label quantity limits

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, and Adults (>=18): at least 5% weight loss during initial approval period. Adolescents (12-17): at least 5% reduction in baseline BMI during initial approval period. Subsequent renewals beyond 18 months require meeting all renewal criteria plus documentation that patient maintains weight loss achieved during initial approval period. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • No concurrent use of any other weight loss drug(s)
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: This policy is published by Minnesota Medicaid (MHCP). The Anti-Obesity Medications PA criteria page (March 2023) lists Wegovy as a covered drug requiring PA. Initial approval is 6 months; renewal is 12 months. The BMI percentile criterion (>=30 kg/m2 and body weight >60 kg for ages 12-17) is a proxy pediatric threshold rather than a stated percentile. All drugs on the Anti-Obesity list require prior authorization. The preferred/non-preferred status is deferred to the Preferred Drug List.

Policy effective March 1, 2023 · verified June 4, 2026 · source: policy-372.html

Wegovy for Heart Disease Risk Reduction

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

Medicaid

Covered with requirements

What you need to qualify

  • Prescribed by or in consultation with a specialist
  • Established cardiovascular disease

Qualification pathways

You can qualify through any one of these.

MACE Risk Reduction — Initial and Renewal (up to 12 months)

All of:

  • Requested drug is FDA approved for MACE
  • Diagnosis of obesity or overweight
  • Patient meets age limit per FDA-approved label
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity unless medically contraindicated by co-morbidity
  • No concurrent use of any other GLP-1 receptor agonist
  • Diagnosis of established cardiovascular (CV) disease
  • Documentation of management of CV risk factors
  • Requested agent is prescribed by or in consultation with a cardiologist

Documentation to bring

  • Documentation that requested drug is FDA approved for MACE indication
  • Documentation of diagnosis of obesity or overweight
  • Documentation of established cardiovascular (CV) disease
  • Documentation of management of CV risk factors
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity (or medical contraindication)
  • Documentation that no concurrent GLP-1 receptor agonist is being used
  • Prescription by or documentation of consultation with a cardiologist

Quantity limits

  • per FDA-approved label — Per FDA-approved label quantity limits

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for The Weight Management Agents page states initial and renewal approval is up to 12 months; no specific weight-loss threshold is stated for the MACE indication renewal — criteria must be re-met at renewal.

Not covered when

  • No concurrent use of any other GLP-1 receptor agonist

Policy note: This MACE criterion is published on the Weight Management Agents PA criteria page (May 2026 version) by Minnesota Medicaid (MHCP). The policy requires established CV disease but does not specify individual qualifying CV events. Management of CV risk factors is required but specific GDMT medications are not enumerated. Cardiologist prescribing or consultation is required.

Policy effective March 1, 2023 · verified June 4, 2026 · source: policy-372.html

Wegovy for Liver Disease (MASH)

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

Medicaid

Covered with requirements

What you need to qualify

  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH — Initial and Renewal (up to 12 months)

All of:

  • Requested drug is FDA approved for MASH
  • Patient meets age limit per FDA-approved label
  • Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity unless medically contraindicated by co-morbidity
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
  • No concurrent use of any other GLP-1 receptor agonist
  • Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)
  • Moderate to advanced liver fibrosis consistent with stages F2 to F3 fibrosis
  • Requested agent is prescribed by or in consultation with a gastroenterologist or hepatologist

Documentation to bring

  • Documentation that requested drug is FDA approved for MASH indication
  • Documentation of diagnosis of noncirrhotic MASH
  • Documentation of moderate to advanced liver fibrosis consistent with stages F2-F3
  • Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
  • Documentation of initiation of or ongoing regimen of increased physical activity (or medical contraindication)
  • Documentation that no concurrent GLP-1 receptor agonist is being used
  • Documentation of no contraindications (or prescriber attestation that benefits outweigh risks)
  • Prescription by or documentation of consultation with a gastroenterologist or hepatologist

Quantity limits

  • per FDA-approved label — Per FDA-approved label quantity limits

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for The Weight Management Agents page states initial and renewal approval is up to 12 months; no specific continuation threshold beyond re-meeting criteria is stated for the MASH indication.

Not covered when

  • No concurrent use of any other GLP-1 receptor agonist
  • Cirrhotic MASH is excluded (noncirrhotic only)
  • No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: This MASH criterion is published on the Weight Management Agents PA criteria page (May 2026 version) by Minnesota Medicaid (MHCP). The policy specifies F2-F3 fibrosis (moderate to advanced) but does not detail the confirmation methodology (e.g., FIB-4, FibroScan, biopsy). Gastroenterologist or hepatologist prescribing or consultation is required. The policy explicitly excludes cirrhotic MASH ('noncirrhotic').

Policy effective March 1, 2023 · verified June 4, 2026 · source: policy-372.html

Why Wegovy requests get denied by Minnesota 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. Qualifying weight-related condition not documented with its own diagnosis code.
  4. Prescriber isn't the specialist the plan requires.
  5. Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Minnesota Medicaid cover Wegovy?
Minnesota Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.
What BMI do you need for Wegovy under Minnesota Medicaid?
For weight loss on Medicaid plans, Minnesota Medicaid requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.
How long does a Wegovy approval last with Minnesota Medicaid?
Initial approvals last 6 months, and renewals are granted in 12-month periods.
What does Minnesota Medicaid require to renew Wegovy?
At least 5% weight loss from the starting weight, at least 5% reduction in BMI, and Adults (>=18): at least 5% weight loss during initial approval period. Adolescents (12-17): at least 5% reduction in baseline BMI during initial approval period. Subsequent renewals beyond 18 months require meeting all renewal criteria plus documentation that patient maintains weight loss achieved during initial approval period.
How current is this information?
This page reflects Minnesota Medicaid's written policy as of March 1, 2023, last verified against the source document on June 4, 2026.

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Minnesota 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.