Nevada Medicaid coverage for Ozempic (Heart Disease

Medicaid

Covered with requirements

What you need to qualify

Established cardiovascular disease (MI, stroke, and PAD)
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

CV risk reduction in T2DM with established CVD

All of:

Diagnosis of type 2 diabetes mellitus (T2DM)
Established cardiovascular disease
Documentation of A1C lab results within past 180 days
No history of pancreatitis
Prescribed at FDA-approved dose for T2DM indication
Recipient is appropriate age per FDA label

Documentation to bring

Documentation of T2DM diagnosis
Documentation of established cardiovascular disease
A1C lab result within past 180 days
Confirmation of no history of pancreatitis

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Documentation of positive response from therapy; recipient continues to meet all initial criteria.

Not covered when

History of pancreatitis
Prescribing for weight loss in absence of T2DM indication
Type 1 diabetes

Policy note: This CV risk reduction pathway under the Incretin Mimetics class criteria requires T2DM diagnosis (unlike Wegovy's CV risk exception which explicitly excludes diabetic patients). The class-level criteria cover CV risk reduction only for recipients WITH T2DM and established CVD. Appropriate age per FDA label required.

Policy effective April 6, 2026 · verified June 3, 2026 · source: msm_1200_26_04_06.pdf

Nevada Medicaid coverage for Ozempic (Heart Disease Risk Reduction)