Mississippi Medicaid coverage for Wegovy (Weight Loss)

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