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New York Medicaid

Does New York Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. New York Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 40 or higher. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction

All of:

  • Confirmed diagnosis of cardiovascular disease
  • Patient BMI ≥ 40 kg/m²
  • Patient is participating in lifestyle modifications that support cardiovascular health

Documentation to bring

  • Confirmation of cardiovascular disease diagnosis
  • Baseline BMI documentation (≥ 40 kg/m²)
  • Documentation of participation in lifestyle modifications supporting cardiovascular health

Quantity limits

  • Two treatment attempts per lifetime (lifetime quantity limit)

Policy note: Lifetime quantity limit of two treatment attempts applies. Document is a partial excerpt from what appears to be the New York Medicaid (NYRx) DUR/PDL criteria document. Only the cv risk reduction indication for Wegovy is addressed in this excerpt. The BMI threshold of ≥ 40 kg/m² is notably higher than the FDA label threshold and typical commercial PA thresholds (27-30 kg/m²). Specific qualifying cardiovascular disease events are not enumerated in this excerpt. The standard PA fax form referenced is the New York Rx/Medicaid PA form.

Policy effective April 23, 2026 · verified June 3, 2026 · source: Nyrx Pdp Pdl · View policy document (PDF)

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Questions people ask
Does New York Medicaid cover Wegovy?
Yes. New York Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 40 or higher. Other policy requirements and your plan's benefits also apply.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under New York Medicaid: Mounjaro, Ozempic

Wegovy under other plans: Elevance Health, EmblemHealth, Excellus BCBS, Highmark, Independent Health, Molina Healthcare, Alabama Medicaid, California Medicaid

All insurance plans · All medications

Summary of New York Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.