Minnesota Medicaid coverage for Wegovy (Heart Disease Risk Reduction)

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.

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