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