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Oregon Medicaid

Does Oregon Medicaid cover Ozempic for Type 2 Diabetes?

Yes. Oregon Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026

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Questions people ask
Does Oregon Medicaid cover Ozempic?
Yes. Oregon Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Oregon Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months.
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 Oregon Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Kaiser Permanente Northwest, PacificSource Health, Regence, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid

All insurance plans · All medications

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