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Oklahoma Medicaid

Does Oklahoma Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Oklahoma 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 4, 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.

CV Risk Reduction — initial approval

All of:

  • FDA approved indication to reduce risk of major adverse CV events
  • Member is 45 years of age or older
  • BMI ≥ 27 kg/m2
  • Established CVD with history of qualifying event
  • HbA1c < 6.5% (no T1DM or T2DM)
  • Not using Wegovy in combination with other semaglutide-containing products or any GLP-1 receptor agonist
  • Currently receiving GDMT for CVD (antihypertensives, lipid-lowering agents, antiplatelets) as documented in pharmacy claims history, unless contraindicated
  • Diet and exercise used in conjunction (clinical documentation required)

Plus any one of:

  • Previous myocardial infarction
  • Previous stroke
  • Symptomatic peripheral arterial disease confirmed by intermittent claudication with ankle-brachial index <0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Documentation to bring

  • Documentation of established CVD with qualifying event (previous MI, previous stroke, or symptomatic PAD confirmed by ABI <0.85, revascularization, or amputation due to atherosclerotic disease)
  • Baseline BMI ≥ 27 kg/m2
  • HbA1c lab result confirming < 6.5%
  • Documentation of current GDMT use (antihypertensives, lipid-lowering agents, antiplatelets) via pharmacy claims history, or documentation of contraindication
  • Clinical documentation (e.g., office notes) of diet and exercise discussion with member
  • Confirmation member will not use Wegovy in combination with other semaglutide-containing products or any GLP-1 receptor agonist

Quantity limits

  • all injection strengths — 4 pens per 28 days
  • 25mg tablets — 30 tablets per 30 days

Approval and renewal

  • Initial approval: 2 months
  • Renewal: every 12 months
  • Renewal: Member is tolerating maintenance dosing; member has not developed T1DM or T2DM; member is continuing reduced calorie diet, increased physical activity, and GDMT for CVD where applicable. Note: BMI threshold, established CVD documentation, and age requirement are not explicitly re-verified at continuation per the document.
  • Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

  • Type 2 diabetes mellitus (T2DM excluded; HbA1c must be <6.5%)
  • Concurrent use with other semaglutide-containing products or any GLP-1 receptor agonist
  • Obese or overweight members without established CVD will not be approved
  • Members who cannot tolerate dose escalation after additional 8-week approval will not be approved for continuation
  • Wegovy should be discontinued if member cannot tolerate at least 1.7mg once weekly maintenance dosing
  • Type 1 diabetes

Policy note: Initial approvals are for 8-week titration periods per dose; a separate PA must be submitted for each dose. An additional 8 weeks per dose may be approved for intolerable adverse effects during escalation with documentation. Subsequent (maintenance) approvals are for 1 year. Qualifying PAD events include intermittent claudication with ABI <0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease. Both injection and tablet formulations (25mg) are addressed. Wegovy tablets (oral semaglutide) are included in the CV risk reduction criteria in this document. Last modified date on the Metabolic Disorders page is April 24, 2026.

verified June 4, 2026 · source: Policy 385 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Oklahoma Medicaid cover Wegovy?
Yes. Oklahoma 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 Oklahoma Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 2 months. Renewal: every 12 months.
What does Oklahoma Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Member is tolerating maintenance dosing; member has not developed T1DM or T2DM; member is continuing reduced calorie diet, increased physical activity, and GDMT for CVD where applicable. Note: BMI threshold, established CVD documentation, and age requirement are not explicitly re-verified at continuation per the document. Staying on a maintenance dose of at least 1.7 mg.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Oklahoma Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: HCSC, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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