New York Medicaid coverage for Ozempic (Type 2 Diabetes)

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

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