Medicaid
Covered with requirementsWhat 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