Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 27 or higher
- Prescribed by or in consultation with a specialist
- Established cardiovascular disease (MI, stroke, PAD, and coronary_revascularization)
- On guideline-directed medical therapy
- Not being used to treat type 1 diabetes
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
- To renew, the plan looks for 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 and 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.pdf