Nevada Medicaid

Does Nevada Medicaid cover Wegovy?

Quick answer · Heart Disease Risk Reduction

Nevada Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. BMI of 27 or higher

Last verified June 3, 2026. Policy effective January 5, 2026. Source: msm_1200_26_04_06.pdf. How we verify this data →

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Wegovy for Heart Disease Risk Reduction

What Nevada Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What 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

Wegovy for Liver Disease (MASH)

What Nevada Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered (preferred drug)

What you need to qualify

  • Age 18 and older
  • Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, and MRE, fibrosis stage F2 to F3

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
  • To renew, the plan looks for 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 and 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.pdf

Why Wegovy requests get denied by Nevada Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Prescriber isn't the specialist the plan requires.

Frequently asked questions

Does Nevada Medicaid cover Wegovy?
Nevada Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.
What BMI do you need for Wegovy under Nevada Medicaid?
For heart disease risk reduction on Medicaid plans, Nevada Medicaid requires a BMI of 27 or higher.
How long does a Wegovy approval last with Nevada Medicaid?
Initial approvals last 6 months, and renewals are granted in 6-month periods.
What does Nevada Medicaid require to renew Wegovy?
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.
How current is this information?
This page reflects Nevada Medicaid's written policy as of January 5, 2026, last verified against the source document on June 3, 2026.

Other medications under Nevada Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Nevada Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.