Medicaid
Covered with requirementsWhat you need to qualify
- Age 12 and older
- BMI of 30 or higher
- BMI of 27 or higher with a weight-related condition (HTN, dyslipidemia, OSA, pre-diabetes, T2DM, prior_MI, prior_stroke, and symptomatic_PAD)
- BMI at or above the 95th percentile for age and sex
Qualification pathways
You can qualify through any one of these.
Pediatric (age 12–17): BMI-based
All of:
- Participant is aged 12–17 years
- Documented baseline BMI >= 95th percentile standardized for age and sex
- Medical necessity documented for using Wegovy instead of preferred agent (Zepbound)
Adult (age >= 18): BMI >= 30
All of:
- Participant is aged >= 18 years
- Documented baseline BMI >= 30 kg/m2
- Medical necessity documented for using Wegovy instead of preferred agent (Zepbound)
Adult (age >= 18): BMI >= 27 with comorbidity
All of:
- Participant is aged >= 18 years
- Documented baseline BMI >= 27 kg/m2
- Medical necessity documented for using Wegovy instead of preferred agent (Zepbound)
Plus any one of:
- Hypertension
- Dyslipidemia
- Obstructive sleep apnea
- Pre-diabetes (A1C 5.7–6.4%, fasting glucose 100–125 mg/dL, or 2-hr OGTT 140–199 mg/dL)
- Previous myocardial infarction
- Previous stroke
- Symptomatic peripheral arterial disease (intermittent claudication with ABI < 0.85, peripheral arterial revascularization, or amputation due to ASCVD)
- Type 2 diabetes mellitus
Adult (age >= 18): MASH with F2 or F3 fibrosis (general weight loss pathway)
All of:
- Participant is aged >= 18 years
- Recent liver biopsy or noninvasive techniques confirming MASH with F2 or F3 fibrosis
- Medical necessity documented for using Wegovy instead of preferred agent (Zepbound)
Continuation: Documented compliance with current preferred agent therapy
All of:
- Documented compliance to current preferred agent therapy
Concurrent antipsychotic therapy
All of:
- Documented concurrent therapy with antipsychotic therapy
Documentation to bring
- Documentation of medical necessity explaining why preferred agent (Zepbound) cannot be utilized
- Participant age documentation (>= 12 years)
- For ages 12–17: Documented baseline BMI >= 95th percentile standardized for age and sex
- For ages >= 18 with BMI >= 30: Documented baseline BMI >= 30 kg/m2
- For ages >= 18 with BMI >= 27: Documented baseline BMI >= 27 kg/m2 AND documentation of at least one qualifying comorbidity
- For MASH pathway: Recent liver biopsy or noninvasive techniques confirming MASH with F2 or F3 fibrosis
Quantity limits
- 0.25 mg/0.5 mL pen, 0.5 mg/0.5 mL pen, 1 mg/0.5 mL pen — 2 mL per 28 days
- 1.7 mg/0.75 mL pen, 2.4 mg/0.75 mL pen — 3 mL per 28 days
Approval and renewal
- To renew, the plan looks for staying on a maintenance dose of at least 1.7 mg.
Not covered when
- Concurrent therapy with another GLP-1 receptor agonist
- Unable to complete titration/dose escalation to at least 1.7 mg/dose within 6 months of beginning therapy
Policy note: Wegovy is a non-preferred agent; Zepbound is preferred. Medical necessity for non-preferred use required. Initial approval is for 4 weeks only; subsequent approvals required for each dose during titration until maintenance dose of at least 1.7 mg is achieved. An additional 4 weeks per dose in the titration process may be approved one time with documentation of intolerable adverse effects during dose escalation. Default approval period (once maintenance reached) is 1 year 90 days. This weight_loss entry covers the general BMI-based obesity indication; the CV risk reduction and MASH indications for Wegovy are captured in separate entries. For the weight_loss indication, diabetes is NOT excluded (T2DM is listed as a qualifying comorbidity for the BMI >= 27 pathway).
Policy effective January 29, 2026 · verified June 3, 2026 · source: policy-311.html