Oregon Medicaid

Does Oregon Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

Oregon Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. Diagnosis documented with a code

Last verified June 4, 2026. Policy effective March 1, 2026. Source: Oregon%20Medicaid%20PA%20Criteria%20Guide%20-%20June%201%2C%202026.pdf. How we verify this data →

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Ozempic for Type 2 Diabetes

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

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code
  • Trial of metformin for at least 90 days, or a documented reason it can't be used (["contraindication"])
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

T2DM with metformin failure or contraindication

All of:

  • Diagnosis of Type 2 diabetes mellitus
  • Prescriber will not switch to a preferred product OR preferred product has been considered

Plus any one of:

  • Tried and failed to meet hemoglobin A1C goals with metformin
  • Contraindication to metformin

Documentation to bring

  • ICD-10 diagnosis code for Type 2 diabetes mellitus
  • Documentation of metformin trial and failure to meet A1C goals, OR documentation of metformin contraindication
  • Documentation that prescriber considered switching to a preferred product

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • Type 1 diabetes

Policy note: This is an Oregon Medicaid (PMPDP / Oregon FFS) PA policy. Non-preferred GLP-1 agonists require PA; preferred products do not require PA when used as second-line therapy with metformin. Preferred products are determined by the Oregon P&T Committee and listed at www.orpdl.org. For non-T2DM indications (NASH/MASH, cardiovascular risk reduction, obstructive sleep apnea), the policy refers to a separate weight management PA criteria document not included here. The document does not specify a minimum metformin trial duration in days — it requires evidence of failure to meet A1C goals. Metformin titration schedule is provided in the document.

Policy effective March 1, 2026 · verified June 4, 2026 · source: Oregon%20Medicaid%20PA%20Criteria%20Guide%20-%20June%201%2C%202026.pdf

Why Ozempic requests get denied by Oregon Medicaid

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

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.
  2. Diagnosis code missing or wrong on the request.
  3. No documented metformin trial (dose, dates, and outcome) or a stated reason it can't be used.

Frequently asked questions

Does Oregon Medicaid cover Ozempic?
Oregon Medicaid covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
Do you have to try metformin before Ozempic?
Yes for type 2 diabetes: Oregon Medicaid requires a documented trial of metformin of at least 90 days, or a documented reason it can't be used (["contraindication"]).
How long does a Ozempic approval last with Oregon Medicaid?
Initial approvals last 12 months.
How current is this information?
This page reflects Oregon Medicaid's written policy as of March 1, 2026, last verified against the source document on June 4, 2026.

Other medications under Oregon Medicaid

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Oregon 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.