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Oregon Medicaid

Does Oregon Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. Oregon Medicaid covers Wegovy for liver disease (MASH) 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 Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH — Liver Biopsy Confirmation

All of:

  • Patient is 18 years of age or older
  • Diagnosis of MASH confirmed by liver biopsy
  • Fibrosis stage 2 or 3 as shown by liver biopsy within the past 24 months
  • Medication ordered by, or in consultation with, a hepatologist or gastroenterologist

MASH — Non-Biopsy Clinical Confirmation

All of:

  • Patient is 18 years of age or older
  • Documentation that patient does NOT have ongoing or recent (within 2 years) significant alcohol use or chronic/active viral hepatitis (significant alcohol use defined as >21 drinks/week or >30 g/day in men; >14 drinks/week or >20 g/day in women)
  • Provider attestation or documentation that other causes of hepatic steatosis are not suspected or have been ruled out (e.g., Wilson's disease, lipodystrophy, abetalipoproteinemia, medications such as amiodarone, methotrexate, tamoxifen, corticosteroids)
  • Documentation that patient has, or is receiving drug treatment for, at least 3 of the 5 metabolic risk factors (overweight/obesity/increased waist circumference [BMI ≥25 kg/m2 or ethnicity-adjusted equivalent], hypertension, type 2 diabetes mellitus, hypertriglyceridemia, decreased HDL)
  • Fibrosis stage 2 or 3 as shown by appropriate diagnostic test within the past 24 months (biopsy, VCTE, MRE, or ELF)
  • Medication ordered by, or in consultation with, a hepatologist or gastroenterologist

Documentation to bring

  • ICD-10 diagnosis code for MASH
  • Patient age 18 years or older
  • Liver biopsy confirming MASH with fibrosis stage 2 or 3 (within past 24 months) OR all of: (1) documentation of absence of significant alcohol use (within 2 years) and no chronic/active viral hepatitis; (2) provider attestation ruling out other causes of hepatic steatosis; (3) documentation of at least 3 of 5 metabolic risk factors; (4) fibrosis staging test (VCTE, MRE, ELF, or biopsy) within past 24 months showing stage 2 or 3
  • Order or consultation note from a hepatologist or gastroenterologist

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: At renewal: provider must attest to patient adherence (or adherence apparent from claims history); patient must have had a complete metabolic panel, liver enzymes, or other appropriate biochemical or noninvasive imaging test within the past 12 months to assess disease progression (examples: FIB-4, ELF, VCTE, MRE); if semaglutide initiation was more than 3 years ago, noninvasive imaging (VCTE or MRE) or repeat liver biopsy must have been done within the past 3 years; patient must NOT have evidence of stage F4 fibrosis (cirrhosis) or worsened fibrosis stage since starting semaglutide; documentation of a risk/benefit assessment for ongoing treatment with semaglutide with possible resolution of metabolic comorbidities must be present. If adherence is not confirmed, approve once for 3 months. If monitoring tests are missing, approve once for 3 months. If imaging/biopsy update is missing (>3 years), approve once for 3 months. If risk/benefit assessment is missing, approve once for 3 months.

Not covered when

  • Fibrosis stage F4 (cirrhosis) — triggers denial at renewal
  • Worsening fibrosis stage since starting semaglutide — triggers denial at renewal
  • Active or recent (within 2 years) significant alcohol use
  • Chronic or active viral hepatitis

Policy note: Injection only for MASH indication. Alcohol limit defined as >30 g/day (>21 drinks/week) for men and >20 g/day (>14 drinks/week) for women. The 24-month lookback applies to all fibrosis staging methods listed (biopsy, VCTE, MRE, ELF). At renewal, if semaglutide was initiated more than 3 years ago, a repeat imaging or biopsy within the past 3 years is required. The MASH pathway bypasses the standard BMI and lifestyle program requirements (approval criteria flow goes directly to #14 for MASH). The document also notes liraglutide (Saxenda) is covered for MASH with stage 2 or 3 fibrosis in adults ≥18 years, but liraglutide is not in the in-scope list.

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 liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Oregon Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Oregon Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. At renewal: provider must attest to patient adherence (or adherence apparent from claims history); patient must have had a complete metabolic panel, liver enzymes, or other appropriate biochemical or noninvasive imaging test within the past 12 months to assess disease progression (examples: FIB-4, ELF, VCTE, MRE); if semaglutide initiation was more than 3 years ago, noninvasive imaging (VCTE or MRE) or repeat liver biopsy must have been done within the past 3 years; patient must NOT have evidence of stage F4 fibrosis (cirrhosis) or worsened fibrosis stage since starting semaglutide; documentation of a risk/benefit assessment for ongoing treatment with semaglutide with possible resolution of metabolic comorbidities must be present. If adherence is not confirmed, approve once for 3 months. If monitoring tests are missing, approve once for 3 months. If imaging/biopsy update is missing (>3 years), approve once for 3 months. If risk/benefit assessment is missing, approve once for 3 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, 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.