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Oregon Medicaid

Does Oregon Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Oregon Medicaid covers Wegovy for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

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

    Oregon Medicaid · PA policy · Medicaid

    Effective March 1, 2026. Verified June 4, 2026.

    View PDF Download Original insurer source
  • 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 — Established Cardiovascular Disease

All of:

  • Established cardiovascular disease (history of myocardial infarction, stroke, or symptomatic peripheral arterial disease)
  • Prior weight loss treatment plan administered by a health care provider (e.g., diet and exercise program, nutritional counseling, and/or calorie restricted diet) for at least 3 months within the previous 6 months
  • Patient will be engaged in a weight management lifestyle modification program in addition to pharmacotherapy
  • Patient has been screened for diabetes within the past year with results indicating no diabetes (HbA1c <6.5% or fasting blood glucose <126 mg/dL) OR has a documented type 2 diabetes diagnosis

Documentation to bring

  • ICD-10 diagnosis code for the condition being treated
  • Documentation of established cardiovascular disease (e.g., history of MI, stroke, or symptomatic peripheral arterial disease)
  • Documentation of prior weight loss treatment plan administered by a health care provider for at least 3 months within the previous 6-month timeframe
  • Documentation of type 2 diabetes diagnosis OR diabetes screening results within the past year (HbA1c <6.5% or fasting blood glucose <126 mg/dL)
  • Attestation that patient will be engaged in a weight management lifestyle modification program

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: At least 5% reduction in BMI.
  • Renewal: At renewal: patient must have lost or maintained a BMI reduction of 5% or more, been adherent to therapy per provider attestation, and be continuing with a weight loss treatment plan (diet/exercise, nutritional counseling, and/or calorie restricted diet). The diabetes screening/diagnosis check and T2DM exclusion from initial approval are not re-verified at renewal.

Policy note: Document states: 'Semaglutide is not currently covered for adults who do not have established cardiovascular disease, metabolic dysfunction-associated steatohepatitis (MASH), or type 2 diabetes.' Semaglutide (tablets or injection) is listed for the CV indication in Table 3. At renewal step 5, the renewal pathway for CV disease requires BMI reduction of 5% or more, adherence, and continuation of a weight loss treatment plan. Ozempic/Rybelsus are handled under a separate GLP-1 PA criteria document for T2DM and are not covered under this 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 · View policy document (PDF)

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Questions people ask
Does Oregon Medicaid cover Wegovy?
Yes. Oregon Medicaid covers Wegovy for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Oregon Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Oregon Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. At least 5% reduction in BMI. At renewal: patient must have lost or maintained a BMI reduction of 5% or more, been adherent to therapy per provider attestation, and be continuing with a weight loss treatment plan (diet/exercise, nutritional counseling, and/or calorie restricted diet). The diabetes screening/diagnosis check and T2DM exclusion from initial approval are not re-verified at renewal.
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, Ozempic, Zepbound

Wegovy under other plans: Kaiser Permanente Northwest, PacificSource Health, Regence, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut 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.