Missouri Medicaid coverage for Wegovy (Weight Loss)

Medicaid

Covered with requirements

What 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