Ohio Medicaid

Does Ohio Medicaid cover Wegovy?

Find your Medicaid card name in Ohio

Quick answer · Weight Loss

Ohio Medicaid does not cover it for weight loss on Medicaid.

  • Medicaid: Not covered. Per Ohio Administrative Code (OAC) 5160-9-03, drugs used for the treatment of obesity are not covered by the Ohio Department of Medicaid.

Last verified June 4, 2026. Policy effective February 4, 2025. Source: Pa policy. How we verify this data →

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Wegovy for Weight Loss

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

Medicaid

Not covered

Per Ohio Administrative Code (OAC) 5160-9-03, drugs used for the treatment of obesity are not covered by the Ohio Department of Medicaid.

Policy note: Explicitly excluded by OAC 5160-9-03: 'drugs used for the treatment of obesity are not covered by the Ohio Department of Medicaid.'

Policy effective February 4, 2025 · verified June 4, 2026 · source: Pa policy

Wegovy for Heart Disease Risk Reduction

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

Medicaid

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • Diagnosis documented with a code
  • Established cardiovascular disease (MI, stroke, and PAD)
  • On guideline-directed medical therapy (antiplatelet_agent, aspirin, platelet_aggregation_inhibitor, statin, ezetimibe, fibrate, PCSK9_inhibitor, beta_blocker, ACE_inhibitor, and ARB)

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction (MACE) — Initial Approval

All of:

  • Age >= 45 years
  • Diagnosis is reduction of Major Adverse Cardiovascular Events (MACE)
  • BMI >= 27 kg/m²
  • History of Type 1 or Type 2 diabetes mellitus
  • At least one qualifying established cardiovascular event (MI, stroke, or symptomatic PAD)
  • Receiving standard CV therapy (antiplatelet agent, lipid-lowering therapy, and/or antihypertensive) OR documented inability to take standard CV therapy due to side effects or medical condition

Plus any one of:

  • History of myocardial infarction (heart attack)
  • History of stroke
  • Symptomatic Peripheral Artery Disease: intermittent claudication with ABI < 0.85 at rest
  • Symptomatic Peripheral Artery Disease: peripheral arterial revascularization procedure (endarterectomy, angioplasty, stenting)
  • Symptomatic Peripheral Artery Disease: amputation due to ASCVD

Documentation to bring

  • ICD-10 diagnosis code(s)
  • Patient age >= 45 years
  • Confirmation that diagnosis is for MACE reduction
  • Documentation of BMI >= 27 kg/m²
  • Documentation of history of diabetes (Type 1 or Type 2)
  • Documentation of qualifying CV event: MI with date, OR stroke with date, OR symptomatic PAD (type and date)
  • List of current standard CV therapy medications OR explanation of why patient cannot take standard CV therapy

Not covered when

  • Patients under age 21 must use EPSDT pathway (Standard PA Fillable form) per OAC Rule 5160-1-14

Policy note: Per Ohio Administrative Code (OAC) 5160-9-03, drugs used for the treatment of obesity are NOT covered by the Ohio Department of Medicaid. This PA form is specifically for the MACE reduction indication only. Notably, the GDMT requirement can be satisfied with documentation that the patient is unable to take standard CV therapy due to side effects or another medical condition. The diabetes history requirement (Q4) includes both Type 1 and Type 2 diabetes — this mirrors the SELECT trial population and does NOT exclude diabetes. This differs from the FDA labeling population (overweight/obese without diabetes) used for Wegovy's CV indication more broadly; here diabetes is REQUIRED as per the PA form.

Policy effective February 4, 2025 · verified June 4, 2026 · source: Pa policy

Why Wegovy requests get denied by Ohio Medicaid

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

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. 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.
  3. Diagnosis code missing or wrong on the request.
  4. BMI not documented in the chart notes (or documented without a baseline weight and date).

If weight loss isn't covered on your plan

Ohio Medicaid has separate Wegovy policies that don't depend on the weight loss benefit:

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does Ohio Medicaid cover Wegovy?
Ohio Medicaid does not cover it for weight loss on Medicaid.
What if my plan excludes weight loss medications?
Ohio Medicaid has separate Wegovy policies for heart disease risk reduction, which are covered on some plan types and don't depend on the weight-loss benefit. Wegovy is also available for cash through NovoCare.
How current is this information?
This page reflects Ohio Medicaid's written policy as of February 4, 2025, last verified against the source document on June 4, 2026.

Other medications under Ohio Medicaid

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Ohio 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.