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North Dakota Medicaid

Does North Dakota Medicaid cover Ozempic?

Yes. North Dakota Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

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

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for non-preferred GLP-1 (Ozempic is PREFERRED - no PA required)

All of:

  • Ozempic (semaglutide) is a PREFERRED agent under GLP-1 Agonists section - NO PA required for initial use
  • Non-preferred GLP-1 agents (Trulicity, liraglutide) require: member has been unable to achieve goal A1C (≤7%) or TIR (>70%) despite a 90-day trial of triple combination therapy consisting of Ozempic (for Trulicity, liraglutide must be trialed if semaglutide including Rybelsus is not tolerated), along with metformin, SGLT-2 inhibitor or insulin

Plus any one of:

  • Requested medication prescribed by or in consult with an endocrinologist or diabetes specialist
  • Member has received diabetes education from a diabetic specialist, diabetic educator, or pharmacist (may be accomplished through the MTM program)

Documentation to bring

  • Evidence of inability to achieve goal A1C (≤7%) or TIR (>70%) despite 90-day trial of triple combination therapy (Ozempic + metformin + SGLT-2 inhibitor or insulin), evidenced by paid claims or pharmacy printouts
  • Prescriber attestation of consultation with endocrinologist or diabetes specialist, OR documentation of diabetes education from diabetic specialist, educator, or pharmacist

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Member must have experienced and maintained clinical benefit since starting treatment; must continue to meet initial criteria; must be at least 80% adherent to medication (or provide clinical justification for non-adherence with a plan to improve).

Not covered when

  • DPP-4 inhibitors and GLP-1 agonists are not payable together (therapeutic duplication)
  • GI intolerances typically will not be considered to bypass trial requirements (specific mitigation steps required first)

Policy note: Ozempic (semaglutide) is a PREFERRED GLP-1 agent for diabetes - NO PA required. Non-preferred GLP-1 agents (Trulicity/dulaglutide, liraglutide/Victoza) require PA after failure of triple therapy including Ozempic. For GI intolerance to Ozempic: chart documentation must be submitted showing dietary changes, reduction in meal size, prescription antiemetics, and dose adjustment were trialed for at least two months before bypassing. Rybelsus (semaglutide oral) is also a preferred GLP-1 agent per PDL (no PA required). Note: The document states 'Ozempic and Victoza (brand) are covered without prior authorization by submitting diagnosis code T43.505A, T43.505D, or T43.505S if being used for antipsychotic-induced weight gain' under Weight Loss section.

Policy effective April 1, 2026 · verified June 3, 2026 · source: Pdl 2026.4 · View policy document (PDF)

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Full requirements: Ozempic 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.

MACE risk reduction - non-diabetic patients (Ozempic as step-therapy prerequisite for Wegovy injection)

All of:

  • Member is between ages ≥55 and <75
  • Member does not have diabetes, as evidenced by A1C within normal range without diabetes medication
  • Member has initial BMI ≥27 kg/m2 and <35 kg/m2
  • Member is concurrently taking lipid-lowering and antiplatelet therapy
  • Dose escalation to 2mg of Ozempic (semaglutide) must be tolerated before Wegovy injection will be authorized (2.4mg is the only strength indicated for reduction of MACE)

Plus any one of:

  • Prior myocardial infarction (MI)
  • Prior stroke AND peripheral arterial disease (PAD), as evidenced by intermittent claudication with ankle-brachial index <0.85, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease

Documentation to bring

  • A1C lab result within normal range (confirming no diabetes) without diabetes medication
  • Documentation of baseline BMI ≥27 kg/m2 and <35 kg/m2
  • Documentation of qualifying CV event (prior MI; OR prior stroke AND PAD with ABI <0.85, revascularization, or amputation)
  • Documentation of concurrent lipid-lowering therapy use
  • Documentation of concurrent antiplatelet therapy use
  • Tobacco cessation counseling documentation (if current tobacco user, within past year)
  • Documentation of dose escalation to Ozempic 2mg tolerated (required before Wegovy injection authorized)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: At least 5% reduction in BMI.
  • Renewal: For Wegovy injection: must have tolerated dose escalation to 2mg of Ozempic before Wegovy authorized. Failure defined as: unable to achieve weight loss ≥5% from baseline, OR unable to achieve reduction of BMI ≥5% from baseline, OR experienced a cardiovascular event following a 5% weight loss or 5% reduction of BMI since starting medication.

Not covered when

  • Patients WITH diabetes are not eligible for this MACE indication (diabetes exclusion); they should use the diabetes criteria
  • BMI ≥35 kg/m2 is excluded from this MACE indication
  • Ozempic 2mg is required as step therapy before Wegovy injection for MACE

Policy note: Under the 'Reduction of Major Adverse Cardiovascular Events (MACE)' section, Ozempic is listed as a NON-PREFERRED injectable agent (Wegovy injection and Ozempic are both listed; Wegovy injection is also non-preferred; Wegovy tablets are non-preferred). For diabetic patients qualifying for MACE reduction, the document directs to the diabetes category criteria. The MACE section specifically addresses non-diabetic patients. Ozempic 2mg must be tolerated as a prerequisite step before Wegovy injection for MACE is authorized. The BMI range is ≥27 and <35 kg/m2.

Policy effective April 1, 2026 · verified June 3, 2026 · source: Pdl 2026.4 · View policy document (PDF)

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Full requirements: Ozempic for Kidney Disease (CKD) (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Diabetic Kidney Disease - GLP-1 receptor agonist (no PA required)

All of:

  • Ozempic (semaglutide) is listed as NO PA REQUIRED under Diabetic Kidney Disease - GLP-1 receptor agonist category

Policy note: Under the 'Diabetic Kidney Disease' section, Ozempic (semaglutide) is explicitly listed as a GLP-1 receptor agonist with NO PA REQUIRED. This is a separate formulary listing from the diabetes GLP-1 agonist section. No specific CKD severity criteria (eGFR, UACR) are stated for Ozempic in this section - it appears to be covered without PA for diabetic kidney disease. Kerendia (finerenone) in the same section requires PA and specifies eGFR ≥25 and UACR ≥30 mg/g criteria, but those criteria apply to Kerendia, not Ozempic.

Policy effective April 1, 2026 · verified June 3, 2026 · source: Pdl 2026.4 · View policy document (PDF)

Open on its own page →

Questions people ask
Does North Dakota Medicaid cover Ozempic?
Yes. North Dakota Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with North Dakota Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does North Dakota Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Member must have experienced and maintained clinical benefit since starting treatment; must continue to meet initial criteria; must be at least 80% adherent to medication (or provide clinical justification for non-adherence with a plan to improve). Heart Disease Risk Reduction — Applies to Medicaid plans. At least 5% reduction in BMI. For Wegovy injection: must have tolerated dose escalation to 2mg of Ozempic before Wegovy authorized. Failure defined as: unable to achieve weight loss ≥5% from baseline, OR unable to achieve reduction of BMI ≥5% from baseline, OR experienced a cardiovascular event following a 5% weight loss or 5% reduction of BMI since starting medication.
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 North Dakota Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: BCBS North Dakota, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

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