Oklahoma Medicaid coverage for Wegovy (Liver

Medicaid

Covered with requirements

What you need to qualify

Age 18 and older
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by FibroScan_VCTE, ELF_test, and liver_biopsy, fibrosis stage F2 to F3
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

MASH — initial approval

All of:

FDA approved indication of noncirrhotic MASH
Member is 18 years of age or older
Moderate-to-advanced liver fibrosis (stage F2 or F3) confirmed by at least one accepted method
No chronic liver disease other than metabolic dysfunction-associated steatotic liver disease (MASLD)
No T1DM or T2DM
Metabolic comorbidities appropriately managed (T2DM, dyslipidemia, hypertension) as attested by prescriber
Not using Wegovy in combination with other semaglutide-containing products or any GLP-1 receptor agonist
Diet and exercise used in conjunction (clinical documentation required)
Prescribed by or in consultation with gastroenterologist or hepatologist (or advanced care practitioner supervised by gastroenterologist or hepatologist)

Plus any one of:

FibroScan with VCTE >= 8kPa and CAP >= 280dB/min
ELF biochemical test score >= 9
Liver biopsy showing stage F2 or F3 fibrosis with MASH

Documentation to bring

Results of fibrosis confirmation test (FibroScan VCTE with VCTE >=8kPa and CAP >=280dB/min, OR ELF score >=9, OR liver biopsy showing F2 or F3 fibrosis with MASH)
Clinical documentation (e.g., office notes) of diet and exercise discussion with member
Prescriber attestation that metabolic comorbidities (T2DM, dyslipidemia, hypertension) are being appropriately managed
Confirmation member does not have chronic liver disease other than MASLD
Confirmation member does not have T1DM or T2DM
Confirmation member will not use Wegovy in combination with other semaglutide-containing products or any GLP-1 receptor agonist
Documentation that prescriber is or is in consultation with a gastroenterologist or hepatologist

Quantity limits

all injection strengths — 4 pens per 28 days

Approval and renewal

Initial approval: 2 months
Renewal: every 12 months
To renew, the plan looks for Member is tolerating maintenance dosing; member has not developed T1DM or T2DM; member is continuing a reduced calorie diet and increased physical activity in conjunction with Wegovy. Note: MASH diagnosis and fibrosis staging are not explicitly re-verified at continuation per the document and staying on a maintenance dose of at least 1.7 mg.

Not covered when

Type 2 diabetes mellitus (T2DM excluded — member must not have T1DM or T2DM)
Known liver cirrhosis (stage F4)
Chronic liver disease other than MASLD
Concurrent use with other semaglutide-containing products or any GLP-1 receptor agonist
Obese members without MASH 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. FibroScan threshold for MASH is >=8kPa (vs >=8.5kPa for Rezdiffra criteria). The MASH indication criteria cover Wegovy injection only (not tablets). This document also requires a prior trial of Wegovy at maintenance dosing for at least 3 months as a step-therapy prerequisite for Rezdiffra (resmetirom) — but that is a step-therapy condition for Rezdiffra, not a Wegovy PA criterion. Last modified date on the Metabolic Disorders page is April 24, 2026.

verified June 4, 2026 · source: policy-385.html

Oklahoma Medicaid coverage for Wegovy (Liver Disease (MASH))