Nevada Medicaid coverage for Wegovy (Heart Disease

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

Nevada Medicaid coverage for Wegovy (Heart Disease Risk Reduction)