Skip to content

Nevada Medicaid

Does Nevada Medicaid cover Wegovy?

Yes. Nevada Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV risk reduction in non-diabetic adults with obesity/overweight

All of:

  • Adult age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Prescribed for risk reduction of MACE (cardiovascular death, non-fatal MI, or non-fatal stroke)
  • Obesity or overweight as qualifying weight condition
  • No type 1 or type 2 diabetes
  • No contraindications to Wegovy
  • Not currently utilizing another GLP-1 therapy
  • Documentation of individualized healthy lifestyle counseling received
  • Provider attestation to maintain standard of care for established CV disease
  • Prescribed by or in consultation with a cardiologist or vascular specialist

Plus any one of:

  • Prior myocardial infarction
  • Prior ischemic or hemorrhagic stroke
  • Symptomatic PAD evidenced by intermittent claudication with ABI <0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease
  • Established CV disease verified by specialist with documentation confirming medication is prescribed to reduce recipient's specific CV risk

Documentation to bring

  • Documentation of BMI ≥ 27 kg/m2
  • Documentation of established CV disease (prior MI, prior ischemic or hemorrhagic stroke, symptomatic PAD with ABI <0.85/revascularization/amputation, OR specialist verification of established CV disease)
  • Prescription by or consultation with a cardiologist or vascular specialist
  • Documentation confirming recipient has no type 1 or type 2 diabetes
  • Documentation confirming recipient is not currently on another GLP-1 therapy
  • Documentation confirming no contraindications to Wegovy
  • Documentation that recipient has received individualized healthy lifestyle counseling
  • Provider attestation to maintain standard of care for established CV disease

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Prescriber confirmation of established CV disease AND achievement of 2.4 mg once weekly maintenance dose (injection) or 25 mg daily maintenance dose (tablet), OR prescriber reasoning why maintenance dose is not appropriate. T2DM exclusion is re-verified at continuation (ongoing requirement). BMI and lifestyle counseling not explicitly re-checked at continuation.
  • Renewal: Staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Type 2 diabetes (this CV indication is specific to non-diabetic recipients)
  • Concurrent use of another GLP-1 therapy
  • Any contraindications to Wegovy use
  • Type 1 diabetes

Policy note: Wegovy CV risk reduction is handled as an exception to the general Incretin Mimetics class criteria. Uniquely requires non-diabetic status (explicitly excludes both T1DM and T2DM). Requires specialist prescribing/consultation (cardiologist or vascular specialist). The document references a MASH indication and directs to Section G for those criteria — MASH criteria are NOT present in this document excerpt. Recertification requires achievement of 2.4 mg once weekly injection maintenance dose or 25 mg daily tablet maintenance dose, or prescriber justification why maintenance dose is not appropriate. The document notes both injection and tablet formulations.

verified June 3, 2026 · source: Msm 1200 26 04 06 · View policy document (PDF)

Open on its own page →

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial Approval — MASH

All of:

  • Recipient is 18 years of age or older
  • Diagnosis of noncirrhotic MASH with fibrosis stage 2 or 3 confirmed by liver biopsy, VCTE (e.g., FibroScan), or MRE (submission of medical records required)
  • Recipient does not have any contraindications to Wegovy (e.g., personal or family history of MTC, MEN 2, or hypersensitivity)
  • Recipient is not currently utilizing another GLP-1 therapy
  • Prescriber attestation that medication is being prescribed in conjunction with diet and exercise

Recertification — MASH

All of:

  • Documentation of positive clinical response to therapy

Plus any one of:

  • Recipient is being prescribed the FDA-recommended maintenance dose of 2.4mg weekly
  • Prescriber has indicated dose was decreased to 1.7mg weekly due to intolerance

Documentation to bring

  • Medical records confirming noncirrhotic MASH diagnosis with fibrosis stage 2 or 3 (via liver biopsy, VCTE/FibroScan, or MRE)
  • Documentation that recipient is 18 years of age or older
  • Documentation that recipient has no contraindications to Wegovy (e.g., no personal or family history of MTC or MEN 2, no hypersensitivity)
  • Documentation that recipient is not currently on another GLP-1 therapy
  • Prescriber attestation that medication is prescribed in conjunction with diet and exercise
  • For recertification: documentation of positive clinical response to therapy
  • For recertification: documentation of current dose (2.4mg weekly or 1.7mg weekly with intolerance notation)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Documentation of positive clinical response to therapy required. Recipient must be prescribed FDA-recommended maintenance dose of 2.4mg weekly, OR prescriber has indicated dose was decreased to 1.7mg weekly due to intolerance.
  • Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

  • Decompensated cirrhosis (exclusion criterion from Rezdiffra section context; Wegovy criteria require noncirrhotic MASH)
  • Personal or family history of medullary thyroid carcinoma (MTC)
  • Multiple endocrine neoplasia syndrome type 2 (MEN 2)
  • Hypersensitivity to semaglutide or any component of Wegovy
  • Current use of another GLP-1 therapy

Policy note: This document is Nevada Medicaid (Medicaid Services Manual, Appendix A). Wegovy is the preferred MASH agent — Rezdiffra (resmetirom) requires prior failure, intolerance, or contraindication to Wegovy, or specialist justification that Wegovy would be ineffective. The Wegovy MASH criteria do NOT include a BMI requirement. The document does not address Wegovy for weight loss or cv risk reduction indications. Rezdiffra (resmetirom) is documented in this section but is not an in-scope GLP-1 medication; no criteria entry is emitted for it. DUR Board last reviewed: October 16, 2025. Document effective date: January 5, 2026.

Policy effective January 5, 2026 · verified June 3, 2026 · source: Msm 1200 26 04 06

Open on its own page →

Questions people ask
Does Nevada Medicaid cover Wegovy?
Yes. Nevada Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Nevada Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months. Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Nevada Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Prescriber confirmation of established CV disease AND achievement of 2.4 mg once weekly maintenance dose (injection) or 25 mg daily maintenance dose (tablet), OR prescriber reasoning why maintenance dose is not appropriate. T2DM exclusion is re-verified at continuation (ongoing requirement). BMI and lifestyle counseling not explicitly re-checked at continuation. Staying on a maintenance dose of at least 2.4 mg. Liver Disease (MASH) — Applies to Medicaid plans. Documentation of positive clinical response to therapy required. Recipient must be prescribed FDA-recommended maintenance dose of 2.4mg weekly, OR prescriber has indicated dose was decreased to 1.7mg weekly due to intolerance. Staying on a maintenance dose of at least 1.7 mg.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Nevada Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Molina Healthcare, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

Summary of Nevada Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.