New York Medicaid

Does New York Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

New York Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered (preferred drug). No additional clinical requirements listed.

Last verified June 3, 2026. Policy effective April 23, 2026. Source: nyrx_pdp_pdl.pdf. How we verify this data →

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Ozempic for Type 2 Diabetes

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

Medicaid

Covered (preferred drug)

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

Standard clinical criteria for GLP-1 agonist (T2DM)

All of:

  • Confirmed diagnosis of FDA-approved or compendia-supported indication that is also a Medicaid covered indication

Documentation to bring

  • Confirmation of FDA-approved or compendia-supported diagnosis that is a Medicaid covered indication
  • If concurrent GLP-1 and DPP-IV use: PA required with documentation of clinical rationale

Policy note: Ozempic is listed as a Preferred drug on the NYRx PDL under GLP-1 Receptor Agonists – Type 2 Diabetes with Clinical Criteria (CC). Clinical criteria require: (1) confirmed diagnosis of an FDA-approved or compendia-supported indication that is also a Medicaid covered indication; (2) PA is required if the patient is using a GLP-1 and DPP-IV concurrently. No additional quantitative criteria (A1C, BMI, step therapy) are specified in this document beyond those two requirements.

Policy effective April 23, 2026 · verified June 3, 2026 · source: nyrx_pdp_pdl.pdf

Why Ozempic requests get denied by New York Medicaid

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

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.

Frequently asked questions

Does New York Medicaid cover Ozempic?
New York Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
How current is this information?
This page reflects New York Medicaid's written policy as of April 23, 2026, last verified against the source document on June 3, 2026.

Other medications under New York Medicaid

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes New York 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.