What BMI do you need for Wegovy under North Dakota Medicaid?

For heart disease risk reduction on Medicaid plans, North Dakota Medicaid requires a BMI of 27 or higher.

How long does a Wegovy approval last with North Dakota Medicaid?

Initial approvals last 12 months, and renewals are granted in 12-month periods.

What does North Dakota Medicaid require to renew Wegovy?

At least 5% weight loss from the starting weight, at least 5% reduction in BMI, Failure of Wegovy tablets (for renewal/non-preferred step) 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% BMI reduction since starting medication, and staying on a maintenance dose of at least 2.4 mg.

How current is this information?

This page reflects North Dakota Medicaid's written policy as of April 1, 2026, last verified against the source document on June 3, 2026.

North Dakota Medicaid

Does North Dakota Medicaid cover Wegovy?

Quick answer · Heart Disease Risk Reduction

North Dakota Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.

Medicaid: Covered with requirements. BMI of 27 or higher

Last verified June 3, 2026. Policy effective April 1, 2026. Source: PDL-2026.4.pdf. How we verify this data →

Check your card for your exact plan →

Wegovy for Heart Disease Risk Reduction

What North Dakota Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

Age 55 to 74
BMI of 27 or higher
Prior trial of another GLP-1 medication (Ozempic and Rybelsus)
Established cardiovascular disease (MI, stroke, and PAD)
On guideline-directed medical therapy (lipid-lowering therapy and antiplatelet therapy)
Lab results confirming eligibility
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

Wegovy injection for MACE - requires Ozempic 2mg step therapy

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

Wegovy tablets for MACE - non-preferred, requires 12-month semaglutide injection trial

All of:

All initial MACE criteria above must be met
Member must have failed a 12-month trial of semaglutide injection, as evidenced by paid claims or pharmacy printouts
Dose escalation to 14mg of Rybelsus (semaglutide) must be tolerated before Wegovy tablets will be authorized

Plus any one of:

Unable to achieve weight loss ≥5% from baseline
Unable to achieve reduction of BMI ≥5% from baseline
Experienced a cardiovascular event following a 5% weight loss or 5% BMI reduction since starting medication

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)
For Wegovy injection: documentation of dose escalation to Ozempic 2mg tolerated
For Wegovy tablets (non-preferred): documentation of 12-month failed trial of semaglutide injection; documentation of Rybelsus 14mg tolerated

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, Failure of Wegovy tablets (for renewal/non-preferred step) 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% BMI reduction since starting medication, and staying on a maintenance dose of at least 2.4 mg. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

Patients WITH diabetes are excluded from this MACE indication (must use diabetes criteria)
BMI ≥35 kg/m2 is excluded
Only the 2.4mg strength is indicated for MACE reduction

Policy note: Wegovy injection and Wegovy tablets are both listed as NON-PREFERRED agents in the MACE section. Wegovy injection requires prior dose escalation to Ozempic 2mg as step therapy. Wegovy tablets are non-preferred relative to injection and require a 12-month trial of semaglutide injection with documented failure. For tobacco users, cessation counseling in past year required. BMI range is ≥27 and <35 kg/m2 - upper limit of <35 is notable and more restrictive than typical.

Policy effective April 1, 2026 · verified June 3, 2026 · source: PDL-2026.4.pdf

Wegovy for Liver Disease (MASH)

What North Dakota Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

Prior trial of another GLP-1 medication (Ozempic)
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, ELF_test, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH - Wegovy injection (non-preferred, requires Ozempic 2mg tolerance)

All of:

All general MASH initial criteria met (F2 or F3 fibrosis, specialist prescriber, no terminal diagnosis, alcohol criteria if applicable)
Dose escalation to 2mg weekly of Ozempic (semaglutide) must be tolerated before Wegovy will be authorized

Documentation to bring

Documentation of moderate to severe fibrosis (F2 or F3) by biopsy, FibroScan/VCTE, ELF, MRI-PDFF, or MRE
Prescriber attestation of consultation with endocrinologist, gastroenterologist, or hepatologist
Alcohol use history assessment; if history of alcohol use within past 5 years: PEth <20 ng/mL OR two negative alcohol tests (most recent within 3 months)
Documentation that member does not have terminal diagnosis with life expectancy <1 year
Documentation of dose escalation to Ozempic 2mg weekly tolerated

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Member must have experienced one of: (1) resolution of steatohepatitis AND no worsening of liver fibrosis; (2) improvement of liver fibrosis ≥1 stage AND no worsening of steatohepatitis; (3) both resolution of steatohepatitis AND improvement in fibrosis. Fibrosis and steatosis measured by biopsy, FibroScan/VCTE, ELF, MRI-PDFF, or MRE.

Not covered when

Terminal diagnosis with life expectancy <1 year
Fibrosis stage F0, F1, or F4 not covered - only F2 or F3

Policy note: Wegovy injection is listed as a NON-PREFERRED agent in the MASH section. Requires tolerance of Ozempic 2mg weekly dose escalation as a step therapy prerequisite before Wegovy authorization. All general MASH criteria (F2-F3 fibrosis, specialist, alcohol criteria, no terminal illness) must also be met.

Policy effective April 1, 2026 · verified June 3, 2026 · source: PDL-2026.4.pdf

Why Wegovy requests get denied by North Dakota Medicaid

Based on what this policy asks for. Fix these before the first submission.

Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
BMI not documented in the chart notes (or documented without a baseline weight and date).
Required prior medication trials not documented.
Prescriber isn't the specialist the plan requires.
Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does North Dakota Medicaid cover Wegovy?: North Dakota Medicaid covers Wegovy for heart disease risk reduction with prior authorization on Medicaid.
What BMI do you need for Wegovy under North Dakota Medicaid?: For heart disease risk reduction on Medicaid plans, North Dakota Medicaid requires a BMI of 27 or higher.
How long does a Wegovy approval last with North Dakota Medicaid?: Initial approvals last 12 months, and renewals are granted in 12-month periods.
What does North Dakota Medicaid require to renew Wegovy?: At least 5% weight loss from the starting weight, at least 5% reduction in BMI, Failure of Wegovy tablets (for renewal/non-preferred step) 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% BMI reduction since starting medication, and staying on a maintenance dose of at least 2.4 mg.
How current is this information?: This page reflects North Dakota Medicaid's written policy as of April 1, 2026, last verified against the source document on June 3, 2026.

Other medications under North Dakota Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes North Dakota Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.