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)