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North Dakota Medicaid · Liver Disease (MASH)

North Dakota Medicaid coverage for Wegovy (Liver Disease (MASH))

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

All Wegovy policies under North Dakota Medicaid · Check your card