Medicaid
Covered with requirementsWhat you need to qualify
- A1C of 7% or higher
- Diagnosis documented with a code
- Trial of metformin for at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"])
- Prior trial of 2 other GLP-1 medications (preferred GLP-1 RA agents (e.g., Ozempic, Trulicity, Victoza))
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
Non-Preferred Agent: Failed Two Preferred GLP-1 RAs
All of:
- Failed trial of TWO preferred agents within GLP-1 RA class
- Diagnosis of diabetes with HbA1C ≥ 7
Plus any one of:
- Trial of metformin
- Contraindication to metformin
- Intolerance to metformin
Documentation to bring
- Documentation of Type II diabetes diagnosis
- HbA1C lab result ≥ 7
- Documentation of trial and failure of TWO preferred GLP-1 RA agents
- Documentation of metformin trial or contraindication/intolerance to metformin
Policy note: Mounjaro (tirzepatide) is listed as a non-preferred agent under the GLP-1 RA class on Nebraska Medicaid's PDL. Non-preferred agents require failure of TWO preferred GLP-1 RA agents, diabetes diagnosis with HbA1C ≥ 7, and metformin trial or contraindication/intolerance. The document notes 'AL' (age limit) and 'QL' (quantity limit) flags for Mounjaro, but specific thresholds are not detailed in this excerpt. The 'PEN' notation indicates this applies to the pen formulation.
Policy effective June 1, 2026 · verified June 4, 2026 · source: NE_PDL-20260601.pdf