Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
- Prior trial of 2 other GLP-1 medications (Trulicity, Byetta, and Victoza) for at least 84 days
Qualification pathways
You can qualify through any one of these.
Non-Preferred: Step therapy from preferred agents with T2DM diagnosis
All of:
- Documented diagnosis of Type 2 Diabetes
- No history of Saxenda or Wegovy in the past 30 days
- 84 days of therapy with Trulicity in the past 6 months
- 84 days of therapy with either preferred Byetta or Victoza in the past 6 months
Non-Preferred: Continuity of care with T2DM diagnosis
All of:
- Documented diagnosis of Type 2 Diabetes
- 84 days of therapy with the requested agent in the past 105 days
Documentation to bring
- Documented diagnosis of Type 2 Diabetes
- Documentation of no Saxenda or Wegovy use in the past 30 days (for step-therapy pathway)
- Documentation of 84 days of Trulicity therapy in the past 6 months (for step-therapy pathway)
- Documentation of 84 days of therapy with Byetta or Victoza in the past 6 months (for step-therapy pathway)
- Documentation of 84 days of therapy with the requested agent in the past 105 days (for continuity pathway)
Not covered when
- History of Saxenda or Wegovy in the past 30 days (for step-therapy pathway)
- Concomitant use of a GLP-1 agonist and a DPP-4 agent requires clinical review
Policy note: Ozempic is listed as a non-preferred agent with minimum age of 18 years. Two distinct non-preferred qualification pathways exist: (1) step therapy through Trulicity + Byetta or Victoza for T2DM patients without recent Saxenda/Wegovy use, or (2) continuity of care (84 days of the requested agent in the past 105 days) with T2DM diagnosis. Concomitant use with a DPP-4 agent requires clinical review. The document does not address Ozempic for cv_risk_reduction or ckd indications.
Policy effective March 1, 2026 · verified June 4, 2026 · source: MS-Medicaid-PDL_March-2026_v1_Updated-02-26-2026.pdf