Does Mississippi Medicaid cover Wegovy?

What you need to qualify

• Age 12 and older
• BMI of 30 or higher
• BMI of 25 or higher with a weight-related condition (HTN, hyperlipidemia, glucose_dysregulation, OSA, CVD, and MASLD)
• BMI at or above the 95th percentile for age and sex

Qualification pathways

You can qualify through any one of these.

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
• To renew, the plan looks for at least 5% weight loss from the starting weight and 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. Make sure your starting weight and date are in the chart now — renewal is measured against it.

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.pdf

What you need to qualify

• Prescribed by or in consultation with a specialist
• Confirmed MASH diagnosis by FIB-4, FibroScan_VCTE, and liver_biopsy, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

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
• To renew, the plan looks for 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 and 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.pdf