Medicaid
Covered with requirementsWhat you need to qualify
- BMI of 40 or higher
- 6 months of a documented diet and exercise program
- Established cardiovascular disease
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.pdf