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Mississippi Medicaid

Does Mississippi Medicaid cover Wegovy?

Yes. Mississippi Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 25 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy documents

  • Anti Obesity Select Agents PA Criteria 04 01 2026 To Current.V10

    Mississippi Medicaid · PA policy · Medicaid

    Effective April 1, 2026. Verified June 4, 2026.

    View PDF Download Original insurer source

  • Wegovy In Mash PA Criteria 10 30 2025 To Current.V1

    Mississippi Medicaid · PA policy · Medicaid

    Effective October 30, 2025. Verified June 4, 2026.

    View PDF Download Original insurer source
  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Mississippi

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Adults (18+) — BMI ≥ 30

All of:

  • Age 18 or older
  • BMI ≥ 30 kg/m²

Adults (18+) — BMI 25–29 with qualifying comorbidity

All of:

  • Age 18 or older
  • BMI 25 to 29 kg/m²

Plus any one of:

  • Hypertension — confirmed by claims history of antihypertensive medication
  • Hyperlipidemia — confirmed by claims history of antihyperlipidemic medication OR documented lipid panel
  • Glucose dysregulation — diabetes with history of glucose-lowering medication OR pre-diabetes (fasting glucose >100, 2-hour OGTT >140, or HbA1C >5.7%)
  • Obstructive sleep apnea — confirmed by prior sleep study
  • Cardiovascular disease — coronary artery disease, heart failure, prior MI or CVA
  • MASLD (metabolic dysfunction-associated steatotic liver disease; formerly NAFLD)
  • Other — with detailed clinical justification attached

Pediatric patients (ages 12–17) — Wegovy

All of:

  • Age 12 to 17 years
  • BMI at >95th percentile for age and sex per CDC growth charts

Documentation to bring

  • Patient current BMI, current weight, current height, and dates of measurement
  • 12-month treatment goal BMI/weight
  • Obesity treatment plan attached to PA form
  • Documentation that patient has been counseled on appropriate dietary choices and increasing physical activity
  • For BMI 25–29 (adults): documentation of qualifying comorbidity (antihypertensive medication claims, antihyperlipidemic medication claims or lipid panel results with values and dates, glucose-lowering medication claims or pre-diabetes lab values with dates, prior sleep study, diagnosis of CVD/CAD/heart failure/prior MI or CVA, MASLD diagnosis, or detailed clinical justification for 'other')
  • For pediatric patients: BMI percentile documentation using CDC growth charts or extended BMI-for-age charts
  • Reauthorization: adherence evidence (at least 9 paid pharmacy claims in past year), documentation of tolerating maintenance/target dose or explanation if not, BMI/weight at initial authorization and current, and evidence of ≥5% weight loss from baseline (adults) or BMI reduction/maintenance (pediatric)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: At least 5% weight loss from the starting weight.
  • Renewal: At reauthorization, member must: (1) have been adherent (at least 9 paid pharmacy claims in the past year); (2) be tolerating the recommended maintenance or target dosage per package insert (or provide explanation if not); AND (3) meet one of: (a) for pediatric patients, achieved or maintained a reduction from baseline BMI, OR (b) achieved or maintained weight loss of 5% or greater from baseline weight. If treatment goal was not reached, clinical justification for continuation must be provided.

Not covered when

  • Breastfeeding mothers
  • Concurrent use of two or more obesity agents not allowed (only one covered obesity product at a time)
  • Concomitant use with other GLP-1 agonists or DPP-4 inhibitors contraindicated
  • Patients with multiple endocrine neoplasia syndrome type 2 (MEN2) or personal/family history of medullary thyroid carcinoma should avoid Wegovy
  • Medicare Part D members: Medicare Part D must be exhausted including appeal before MS Medicaid covers; copy of appeal denial letter required
  • Pregnancy

Policy note: Mississippi Medicaid covers select obesity agents only. Wegovy is a Preferred agent for ages 12 and older. Saxenda is also covered as a preferred agent (not in scope for this extraction but listed in the document). Non-preferred agents (Xenical/orlistat) also covered for ages 12+. Contrave, Qsymia, phentermine, and Evekeo/amphetamine are explicitly not covered. Only one covered obesity product may be used at a time — concurrent use of two or more agents is not covered. The document's date '04/01/2026' appears in the footer/confidentiality notice and is used as expiration date (next-review/effective date context is ambiguous but most likely a future effective or review date). BMI 25–29 threshold for Wegovy in adults with comorbidity (vs. BMI 27–29 for Saxenda). Pediatric Saxenda criteria (weight >60 kg and BMI corresponding to adult ≥30 by international cut-offs) are not in scope for this extraction.

Policy effective April 1, 2026 · verified June 4, 2026 · source: Anti Obesity Select Agents PA Criteria 04 01 2026 To Current.V10 · View policy document (PDF)

Open on its own page →

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initial Authorization — MASH with moderate to advanced fibrosis

All of:

  • Age within range recommended by FDA label (adults)
  • Diagnosis of noncirrhotic MASH (formerly NASH) with moderate to advanced liver fibrosis consistent with stages F2 to F3, confirmed by clinical presentation along with laboratory findings and/or imaging and/or biopsy results
  • Patient does NOT have decompensated cirrhosis
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Prescriber attests Wegovy will be used in conjunction with diet and exercise and without excessive alcohol consumption
  • Prescribed dosage does not exceed Wegovy 2.4 mg subcutaneously once weekly

Re-Authorization — Continuation of MASH therapy

All of:

  • Patient continues to meet initial authorization requirements
  • Documentation of positive clinical response to therapy (e.g., improvement or stabilization of fibrosis)
  • Patient is maintained on Wegovy 2.4 mg or 1.7 mg weekly

Documentation to bring

  • Completed Universal PA Form
  • Supporting clinical documentation confirming MASH diagnosis with F2–F3 fibrosis (laboratory findings and/or imaging and/or biopsy results)
  • Documentation confirming absence of decompensated cirrhosis
  • Confirmation that prescription is by or in consultation with a gastroenterologist or hepatologist
  • Prescriber attestation that Wegovy will be used with diet and exercise and without excessive alcohol consumption
  • For re-authorization: documentation of positive clinical response (improvement or stabilization of fibrosis)

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Documentation of positive clinical response to therapy (e.g., improvement or stabilization of fibrosis) required. Patient must continue to meet initial authorization requirements and be maintained on Wegovy 2.4 mg or 1.7 mg weekly.
  • Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

  • Decompensated cirrhosis

Policy note: Policy is specific to Mississippi Division of Medicaid. Indication is noncirrhotic MASH with moderate to advanced fibrosis (F2–F3) in adults only. Maintenance dose target is 2.4 mg weekly; 1.7 mg is acceptable if 2.4 mg cannot be tolerated. The document does not specify lookback periods for biopsy or imaging, nor explicit alcohol gram limits — only a prescriber attestation of 'without excessive alcohol consumption' is required. No explicit quantity limits are stated in this document beyond the maximum dose of 2.4 mg subcutaneously once weekly.

Policy effective October 30, 2025 · verified June 4, 2026 · source: Wegovy In Mash PA Criteria 10 30 2025 To Current.V1 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Mississippi Medicaid cover Wegovy?
Yes. Mississippi Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 25 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Mississippi Medicaid?
Weight Loss — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Mississippi Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. At least 5% weight loss from the starting weight. At reauthorization, member must: (1) have been adherent (at least 9 paid pharmacy claims in the past year); (2) be tolerating the recommended maintenance or target dosage per package insert (or provide explanation if not); AND (3) meet one of: (a) for pediatric patients, achieved or maintained a reduction from baseline BMI, OR (b) achieved or maintained weight loss of 5% or greater from baseline weight. If treatment goal was not reached, clinical justification for continuation must be provided. Liver Disease (MASH) — Applies to Medicaid plans. Documentation of positive clinical response to therapy (e.g., improvement or stabilization of fibrosis) required. Patient must continue to meet initial authorization requirements and be maintained on Wegovy 2.4 mg or 1.7 mg weekly. Staying on a maintenance dose of at least 1.7 mg.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Card and program names on file in Mississippi

These names map to Mississippi Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Mississippi Medicaid: Mounjaro, Ozempic

Wegovy under other plans: Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

Summary of Mississippi Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.