Molina Healthcare

Does Molina Healthcare cover Wegovy?

Quick answer · Weight Loss

Molina Healthcare does not cover it for weight loss on ACA Marketplace.

  • ACA Marketplace: Not covered. In states where weight loss drugs are a benefit exclusion, Wegovy (semaglutide) injection and tablets are considered a benefit exclusion for all indications, including but not limited to weight reduction and chronic weight management. Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage. Wegovy (semaglutide) is excluded from coverage for overweight/obesity per Social Security 1927 (d)(3)(A) as an agent when used for anorexia, weight loss, or weight gain. California and New Mexico Marketplace have state-specific exceptions.

Last verified June 11, 2026. Policy effective May 30, 2026. Source: D84835628C9549BFB30D1D6F9EDBAC8E.ashx. How we verify this data →

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Wegovy for Weight Loss

What Molina Healthcare requires, by plan type. Open this indication on its own page →

ACA Marketplace

Not covered

In states where weight loss drugs are a benefit exclusion, Wegovy (semaglutide) injection and tablets are considered a benefit exclusion for all indications, including but not limited to weight reduction and chronic weight management. Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage. Wegovy (semaglutide) is excluded from coverage for overweight/obesity per Social Security 1927 (d)(3)(A) as an agent when used for anorexia, weight loss, or weight gain. California and New Mexico Marketplace have state-specific exceptions.

Exceptions

  • California: Per California Title 28, plans are not required to cover weight loss drugs except when medically necessary for morbid obesity. Plans may require enrollment in a comprehensive weight loss program prior to or concurrent with the prescription. See Weight Management Therapy CA MMKP C28425-A.
  • New Mexico: Prescription drugs medically necessary for the treatment of obesity and morbid obesity are covered. Treatments and medications for the purpose of weight reduction or control are not covered except for medically necessary treatment of morbid obesity and obesity. See Weight Management Therapy NM MMKP C29220-A.

Policy note: This is a Molina Healthcare Marketplace policy. Weight loss drugs are benefit exclusions under the Marketplace Evidence of Coverage and per Social Security 1927(d)(3)(A). California and New Mexico Marketplace have state-specific criteria referenced in separate policies. Phendimetrazine and phentermine are noted as on formulary for New Mexico.

Policy effective May 30, 2026 · verified June 11, 2026 · source: D84835628C9549BFB30D1D6F9EDBAC8E.ashx

Wegovy for Heart Disease Risk Reduction

What Molina Healthcare requires, by plan type. Open this indication on its own page →

ACA Marketplace

Not covered

In states where weight loss drugs are a benefit exclusion, Wegovy (semaglutide) injection and tablets are considered a benefit exclusion for ALL indications, including but not limited to weight reduction to lower risk for repeat cardiovascular event in individuals with history of prior heart attack or stroke. Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage.

Exceptions

  • California: See Weight Management Therapy CA MMKP C28425-A for state-specific criteria.
  • New Mexico: See Weight Management Therapy NM MMKP C29220-A for state-specific criteria.

Policy note: The policy explicitly states Wegovy is a benefit exclusion for ALL indications including weight reduction to lower CV risk. The CV risk reduction indication is not separately adjudicated — it is swept under the blanket weight-loss benefit exclusion for Marketplace. The background section describes the SELECT trial population (adults ≥45 years, BMI ≥27, established CVD including prior MI, stroke, or PAD, and no T1D or T2D) but these are informational only and do not constitute coverage criteria since the indication is excluded.

Policy effective May 30, 2026 · verified June 11, 2026 · source: D84835628C9549BFB30D1D6F9EDBAC8E.ashx

Wegovy for Liver Disease (MASH)

What Molina Healthcare requires, by plan type. Open this indication on its own page →

ACA Marketplace

Not covered

In states where weight loss drugs are a benefit exclusion, Wegovy (semaglutide) injection and tablets are considered a benefit exclusion for ALL indications, including but not limited to metabolic dysfunction-associated steatohepatitis (MASH). Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage.

Exceptions

  • California: See Weight Management Therapy CA MMKP C28425-A for state-specific criteria.
  • New Mexico: See Weight Management Therapy NM MMKP C29220-A for state-specific criteria.

Policy note: The policy explicitly states Wegovy is a benefit exclusion for ALL indications including MASH. The FDA-approved MASH indication (noncirrhotic MASH with moderate to advanced liver fibrosis, stages F2 to F3) is noted in the FDA-Approved Uses section informally, but no PA criteria are established because the drug is excluded under the blanket Marketplace weight-loss benefit exclusion. The MASH indication received accelerated FDA approval and continued approval is contingent upon confirmatory trial results per the prescribing information.

Policy effective May 30, 2026 · verified June 11, 2026 · source: D84835628C9549BFB30D1D6F9EDBAC8E.ashx

Why Wegovy requests get denied by Molina Healthcare

Based on what this policy asks for. Fix these before the first submission.

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.

If weight loss isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Molina Healthcare about a formulary exception, and check whether your employer's plan can add the benefit.

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does Molina Healthcare cover Wegovy?
Molina Healthcare does not cover it for weight loss on ACA Marketplace.
What if my plan excludes weight loss medications?
A prior authorization can't override a benefit exclusion; ask the plan about a formulary exception. Wegovy is also available for cash through NovoCare.
How current is this information?
This page reflects Molina Healthcare's written policy as of May 30, 2026, last verified against the source document on June 11, 2026.

Other medications under Molina Healthcare

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Molina Healthcare's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.