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North Carolina Medicaid

Does North Carolina Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. North Carolina Medicaid covers Wegovy for liver disease (MASH) with prior authorization if your BMI is 25 or higher. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

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

Earliest policy review June 4, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

NASH/MASH with F1–F3 fibrosis — Adult ≥ 18

All of:

  • Diagnosis of noncirrhotic NASH or MASH
  • Adult (18 years of age or over)
  • Medical records required
  • Stage F1, F2, or F3 fibrosis confirmed by BOTH: (1) FIB-4 score consistent with F1–F3 fibrosis adjusted for age, AND (2) at least one of: liver biopsy, VCTE/FibroScan, ELF score, MRE, or FibroSure
  • Requested agent is Wegovy
  • Being monitored for development of and/or treated for any comorbid conditions (e.g., CVD, diabetes, dyslipidemia, hypertension)
  • No decompensated cirrhosis
  • No moderate to severe hepatic impairment (Child-Pugh Class B or C)
  • No other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
  • Currently on and will continue lifestyle modification including structured nutrition and physical activity
  • Will NOT use in combination with another GLP-1 receptor agonist
  • No FDA-labeled contraindications

Plus any one of:

  • Baseline BMI > 25 kg/m² prior to beginning therapy
  • Baseline BMI > 23 kg/m² if beneficiary is of South Asian, Southeast Asian, or East Asian descent

Documentation to bring

  • Medical records confirming diagnosis of noncirrhotic NASH or MASH
  • FIB-4 score consistent with stage F1, F2, or F3 fibrosis (adjusted for age)
  • At least one confirmatory test result: liver biopsy, VCTE/FibroScan, ELF score, MRE, or FibroSure
  • Baseline BMI documentation (>25 kg/m², or >23 kg/m² for South/Southeast/East Asian descent)
  • Documentation of alcohol consumption (female <20 g/day, male <30 g/day)
  • Documentation of monitoring or treatment for comorbid conditions (CVD, diabetes, dyslipidemia, hypertension)
  • Documentation confirming absence of decompensated cirrhosis, Child-Pugh B/C hepatic impairment, and other liver disease

Quantity limits

  • titration doses — 2 mL per 28 days
  • maintenance doses — 3 mL per 28 days

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Medical documentation that beneficiary has improved while on medication AND individual clinical goals set by provider are being met OR beneficiary is continuing to make adequate progress towards treatment goals. Continued lifestyle modification required. No combination with another GLP-1. No FDA-labeled contraindications. Provider must document review of medication list at each renewal for possible dose reductions or discontinuation of comorbid medications. Note: Covered indication went into effect October 1, 2025; prior PA approval through Medicaid required before renewal.

Not covered when

  • Decompensated cirrhosis
  • Moderate to severe hepatic impairment (Child-Pugh Class B or C)
  • Any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
  • Concurrent use with another GLP-1 receptor agonist
  • Medullary thyroid carcinoma history
  • Multiple endocrine neoplasia syndrome type 2 (MEN2)
  • Lactation
  • Pregnancy

Policy note: Fibrosis staging requires BOTH a FIB-4 score AND at least one additional confirmatory test (liver biopsy, VCTE/FibroScan, ELF, MRE, or FibroSure). No explicit lookback periods are specified for these tests in the document. The Asian descent BMI threshold (>23 kg/m²) applies to South Asian, Southeast Asian, and East Asian patients. The document labels this indication as NASH or MASH (noncirrhotic). Covered indication went into effect October 1, 2025 per renewal section.

Policy effective August 1, 2024 · verified June 4, 2026 · source: North Carolina Medicaid Medicaid prior authorization policy

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Questions people ask
Does North Carolina Medicaid cover Wegovy?
Yes. North Carolina Medicaid covers Wegovy for liver disease (MASH) with prior authorization if your BMI is 25 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with North Carolina Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does North Carolina Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. Medical documentation that beneficiary has improved while on medication AND individual clinical goals set by provider are being met OR beneficiary is continuing to make adequate progress towards treatment goals. Continued lifestyle modification required. No combination with another GLP-1. No FDA-labeled contraindications. Provider must document review of medication list at each renewal for possible dose reductions or discontinuation of comorbid medications. Note: Covered indication went into effect October 1, 2025; prior PA approval through Medicaid required before renewal.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under North Carolina Medicaid: Zepbound

Wegovy under other plans: BCBS North Carolina, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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