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North Dakota Medicaid

Does North Dakota Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. North Dakota Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 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.

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
  • Renewal: At least 5% reduction in BMI.
  • Renewal: 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.
  • Renewal: Staying on a maintenance dose of at least 2.4 mg.

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 · View policy document (PDF)

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Questions people ask
Does North Dakota Medicaid cover Wegovy?
Yes. North Dakota Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with North Dakota Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does North Dakota Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. 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. Staying on a maintenance dose of at least 2.4 mg.
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, Ozempic, Zepbound

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

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.