Applies to Medicaid plans.
Covered with requirementsQualification 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
- Renewal: 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 · View policy document (PDF)