Molina Healthcare coverage for Wegovy (Liver Disease (MASH))

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