Medicaid
Covered (preferred drug)What you need to qualify
- Trial of metformin for at least 365 days, or a documented reason it can't be used
Qualification pathways
You can qualify through any one of these.
Preferred agent — metformin trial
All of:
- Ozempic is a preferred agent
- Adequate therapeutic trial of metformin in the past year
Preferred agent — prior GLP-1 history
All of:
- Ozempic is a preferred agent
- Prior history with a GLP-1 agonist in the past 3 months
Documentation to bring
- Documentation of adequate therapeutic trial of metformin in the past year OR documentation of prior GLP-1 agonist use in the past 3 months
Quantity limits
- 0.25 mg/dose, 0.5 mg/dose (1.5 mL pen) — 1.5 mL per 28 days
- 0.25 mg/dose (2 mg/3 mL pen), 1 mg/dose (2 mg/1.5 mL pen), 1 mg/dose (4 mg/3 mL pen), 2 mg/dose (8 mg/3 mL pen) — 3 mL per 28 days
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
Not covered when
- Concurrent therapy with another GLP-1 receptor agonist
Policy note: Ozempic is a preferred agent on the MO HealthNet PDL. For preferred agents, approval requires either an adequate therapeutic trial of metformin in the past year OR prior history with a GLP-1 agonist in the past 3 months. Denial code '0160' (Preferred Drug List) applies when criteria not met. GLP-1 receptor agonists indicated for anti-obesity/obesity are covered under a separate PDL edit.
Policy effective January 9, 2025 · verified June 3, 2026 · source: policy-310.html