How long does a Wegovy approval last with New Hampshire Medicaid?

Initial approvals last 12 months, and renewals are granted in 12-month periods.

What does New Hampshire Medicaid require to renew Wegovy?

Patient must continue to meet all initial approval criteria AND demonstrate disease improvement evidenced by NASH resolution or improvement in liver fibrosis AND must not have experienced treatment-restricting adverse effects (e.g., hepatotoxicity, gallbladder-related adverse reactions, statin-related adverse reactions when given concurrently with a statin).

How current is this information?

This page reflects New Hampshire Medicaid's written policy as of October 1, 2025, last verified against the source document on June 4, 2026.

Does New Hampshire Medicaid cover Wegovy?

Wegovy for Liver Disease (MASH)

What New Hampshire 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
6 months of a documented diet and exercise program
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, MRE, and ELF_test, fibrosis stage F2 to F3
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial approval — MASH with moderate-to-advanced fibrosis

All of:

Patient is 18 years of age or older
Prescribed by or in consultation with a gastroenterologist or hepatologist
Diagnosis of MASH (previously NASH)
Moderate to advanced liver fibrosis (F2–F3) confirmed by at least one accepted method (liver biopsy within 2 years, FibroScan VCTE, MRE, or biochemical fibrosis test)
MRI-PDFF >= 8% liver fat
Currently treated with a statin and will continue it, OR intolerance/hypersensitivity/contraindication to all statins
Patient has implemented lifestyle modifications (diet, exercise)
No history of significant alcohol consumption >3 consecutive months within previous 12 months
No hepatocellular carcinoma (HCC)
No other liver disease (e.g., Wilson's disease, hepatitis)
No MELD score >= 12 unless due to therapeutic anticoagulation
No history of bariatric surgery within the past year

Fibrosis confirmation — liver biopsy route

All of:

Liver biopsy within past 2 years confirming steatosis
NAFLD activity score (NAS) >= 4
Score >= 1 in each NAS component (steatosis, ballooning degeneration, lobular inflammation)
Fibrosis stage 1, 2, or 3

Fibrosis confirmation — non-invasive imaging/lab route

Plus any one of:

FibroScan (VCTE) >= 8.5 kPa AND CAP score >= 280 dB/m
MRE >= 2 but < 4
PRO-C3 > 14 ng/mL
ELF score >= 9

Documentation to bring

Documentation of MASH (previously NASH) diagnosis
Confirmation of prescriber is or has consulted a gastroenterologist or hepatologist
Liver biopsy report within past 2 years (if using biopsy route): confirming steatosis, NAS >= 4, score >= 1 in each NAS component, and fibrosis stage 1–3
FibroScan (VCTE) results showing >= 8.5 kPa and CAP >= 280 dB/m (if using FibroScan route)
MRE results showing >= 2 and < 4 kPa (if using MRE route)
PRO-C3 lab result > 14 ng/mL OR ELF score >= 9 (if using biochemical route)
MRI-PDFF result showing >= 8% liver fat
Documentation of current statin use and intent to continue, OR documentation of intolerance/hypersensitivity/contraindication to all statins
Documentation of lifestyle modifications implemented (diet, exercise)
Attestation of no significant alcohol consumption (>3 consecutive months) in the past 12 months
Attestation of no hepatocellular carcinoma, no other liver disease, MELD score < 12 (unless due to therapeutic anticoagulation)
Attestation of no bariatric surgery within the past year

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Patient must continue to meet all initial approval criteria AND demonstrate disease improvement evidenced by NASH resolution or improvement in liver fibrosis AND must not have experienced treatment-restricting adverse effects (e.g., hepatotoxicity, gallbladder-related adverse reactions, statin-related adverse reactions when given concurrently with a statin).

Not covered when

History of significant alcohol consumption for more than 3 consecutive months within previous 12 months
Hepatocellular carcinoma (HCC)
Any other liver disease (e.g., Wilson's disease, hepatitis)
MELD score >= 12 unless due to therapeutic anticoagulation
Cirrhotic NASH (only noncirrhotic F2–F3 fibrosis is covered)
Bariatric surgery

Policy note: This is a New Hampshire Medicaid Fee-for-Service policy administered by Prime Therapeutics State Government Solutions LLC. The policy applies to both Wegovy (semaglutide) and Rezdiffra (resmetirom) under the same shared MASH criteria, with criteria items 9 and 10 being Rezdiffra-only (CYP2C8 inhibitor exclusion and OATP1B1/1B3 inhibitor exclusion). Wegovy is not subject to those two exclusions. The liver biopsy fibrosis staging note specifies 'stage 1, 2, or 3' are acceptable under the biopsy route, even though the overall indication targets F2–F3; the biopsy route's minimum fibrosis_stage_min reflects the F2 policy intent per the indication description. The document does not specify quantity limits for Wegovy. The statin requirement is effectively a GDMT-type requirement specific to MASH management. Renewal requires continued adherence to all initial criteria plus documented disease improvement and absence of treatment-restricting adverse effects.

Policy effective October 1, 2025 · verified June 4, 2026 · source: 4a490bb0-6ec4-9e4c-09a5-2c257b186da2

Why Wegovy requests get denied by New Hampshire Medicaid

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

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.
No documented diet and exercise program.
Prescriber isn't the specialist the plan requires.

Frequently asked questions

Does New Hampshire Medicaid cover Wegovy?: New Hampshire Medicaid covers Wegovy for liver disease (mash) with prior authorization on Medicaid.
How long does a Wegovy approval last with New Hampshire Medicaid?: Initial approvals last 12 months, and renewals are granted in 12-month periods.
What does New Hampshire Medicaid require to renew Wegovy?: Patient must continue to meet all initial approval criteria AND demonstrate disease improvement evidenced by NASH resolution or improvement in liver fibrosis AND must not have experienced treatment-restricting adverse effects (e.g., hepatotoxicity, gallbladder-related adverse reactions, statin-related adverse reactions when given concurrently with a statin).
How current is this information?: This page reflects New Hampshire Medicaid's written policy as of October 1, 2025, last verified against the source document on June 4, 2026.