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Missouri Medicaid

Does Missouri Medicaid cover Wegovy?

Yes. Missouri Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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

  • Renewal: 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 · View policy document (PDF)

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Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction (MACE) — Wegovy only

All of:

  • Wegovy (non-preferred) — medical necessity for non-preferred use documented
  • Participant is aged ≥ 45 years
  • Documented baseline BMI ≥ 27 kg/m2
  • Lack of diabetes mellitus diagnosis in the past 2 years
  • Recent A1C < 6.5 within the past 3 months confirming absence of diabetes diagnosis
  • Lack of any history of anti-diabetic pharmaceutical therapy in the past 2 years
  • Documentation of current pharmaceutical therapy for cardiovascular disease

Plus any one of:

  • Documented diagnosis of myocardial infarction
  • Documented diagnosis of stroke
  • Symptomatic peripheral arterial disease — intermittent claudication with ABI < 0.85 (at rest), peripheral arterial revascularization procedure, or amputation due to ASCVD

Documentation to bring

  • Documentation of medical necessity for using Wegovy instead of preferred agent (Zepbound)
  • Participant age documentation (≥ 45 years)
  • Documented baseline BMI ≥ 27 kg/m2
  • Documentation confirming no diabetes mellitus diagnosis in the past 2 years
  • Recent A1C < 6.5 within the past 3 months
  • Documentation confirming no anti-diabetic pharmaceutical therapy in the past 2 years
  • Documented diagnosis of qualifying CV event: myocardial infarction, stroke, or symptomatic PAD (with supporting evidence: ABI < 0.85, revascularization procedure, or amputation due to ASCVD)
  • Documentation of current pharmaceutical therapy for cardiovascular disease

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

  • Renewal: 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
  • Diabetes mellitus diagnosis within past 2 years
  • Any history of anti-diabetic pharmaceutical therapy in past 2 years
  • A1C ≥ 6.5 on recent lab

Policy note: This is a Wegovy-specific pathway. Strictly requires absence of diabetes: no diabetes diagnosis in the past 2 years, no anti-diabetic pharmaceutical therapy in the past 2 years, and recent A1C < 6.5 (within 3 months). CVD pharma therapy is required but not specified beyond 'pharmaceutical therapy for cardiovascular disease.' Titration rules same as Wegovy weight loss: initial approval 4 weeks, per-dose approvals during titration, must reach maintenance dose of at least 1.7 mg/dose within 6 months.

Policy effective January 29, 2026 · verified June 3, 2026 · source: Policy 311 · View policy document (PDF)

Open on its own page →

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH with F2 or F3 fibrosis — Wegovy only

All of:

  • Wegovy (non-preferred) — medical necessity for non-preferred use documented
  • Participant is aged ≥ 18 years
  • Recent liver biopsy or noninvasive techniques confirming MASH with F2 or F3 fibrosis
  • Documented current liver function tests (LFTs)
  • Prescribed by or in consultation with a gastroenterologist, hepatologist, or other specialist in the treated disease state
  • Lack of diabetes mellitus diagnosis in the past 2 years
  • Recent A1C < 6.5 within the past 3 months confirming absence of diabetes diagnosis
  • Lack of any history of anti-diabetic pharmaceutical therapy in the past 2 years

Documentation to bring

  • Documentation of medical necessity for using Wegovy instead of preferred agent (Zepbound)
  • Participant age documentation (≥ 18 years)
  • Recent liver biopsy or noninvasive techniques confirming MASH diagnosis with F2 or F3 fibrosis
  • Documented current liver function tests (LFTs)
  • Prescription from or documentation of consultation with a gastroenterologist, hepatologist, or other specialist in the treated disease state
  • Documentation confirming no diabetes mellitus diagnosis in the past 2 years
  • Recent A1C < 6.5 within the past 3 months
  • Documentation confirming no anti-diabetic pharmaceutical therapy in the past 2 years

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

  • Renewal: 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
  • Cirrhotic MASH (policy states 'noncirrhotic' MASH)
  • Diabetes mellitus diagnosis within past 2 years
  • Any history of anti-diabetic pharmaceutical therapy in past 2 years
  • A1C ≥ 6.5 on recent lab

Policy note: This is a Wegovy-specific MASH pathway. The policy specifies 'noncirrhotic' MASH. The MASH confirmation methods are described as 'recent liver biopsy or noninvasive techniques' — specific noninvasive methods (e.g., FIB-4, FibroScan, MRE, ELF) are not enumerated. No explicit lookback period stated for biopsy or noninvasive tests ('recent' used without definition). Titration rules same as other Wegovy indications. The diabetes exclusion criteria (no DM diagnosis in past 2 years, no anti-diabetic therapy in past 2 years, A1C < 6.5 within 3 months) apply to all Wegovy-specific pathways per the document structure. Specialist requirement: prescribed by or in consultation with a gastroenterologist, hepatologist, or other specialist.

Policy effective January 29, 2026 · verified June 3, 2026 · source: Policy 311 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Missouri Medicaid cover Wegovy?
Yes. Missouri Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
What does Missouri Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. Staying on a maintenance dose of at least 1.7 mg. Heart Disease Risk Reduction — Applies to Medicaid plans. Staying on a maintenance dose of at least 1.7 mg. Liver Disease (MASH) — Applies to Medicaid plans. Staying on a maintenance dose of at least 1.7 mg.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Missouri Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

Summary of Missouri Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.