Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
Qualification pathways
You can qualify through any one of these.
Initial approval for T2DM
All of:
- Diagnosis of type 2 diabetes mellitus
- Patient age supported by FDA-approved indication (adults)
- Medication used as adjunct to diet and exercise
- Trial of an oral antihyperglycemic
Documentation to bring
- Documentation of type 2 diabetes mellitus diagnosis
- Documentation of patient age consistent with FDA-approved indication
- Documentation of prior trial of an oral antihyperglycemic agent
Approval and renewal
- Initial approval: 12 months
Not covered when
- Type 1 diabetes
Policy note: Non-preferred drugs on the Preferred Drug List (PDL) require additional prior authorization. The document does not explicitly address CV risk reduction or CKD indications under the PA criteria section; the table lists Ozempic for MACE risk reduction in T2DM with established CVD, but no separate criteria are established beyond the shared approval criteria. The approval criteria appear to apply uniformly to all GLP-1 agonists listed.
Policy effective June 5, 2025 · verified June 4, 2026 · source: 9105e0b5-0a2e-48dc-d176-594ab9907de5