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Oregon Medicaid

Does Oregon Medicaid cover Wegovy for Weight Loss?

No. Oregon Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.

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: Not covered. Document explicitly states: 'Semaglutide is not currently covered for adults who do not have established ca...

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

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Not covered

Document explicitly states: 'Semaglutide is not currently covered for adults who do not have established cardiovascular disease, metabolic dysfunction-associated steatohepatitis (MASH), or type 2 diabetes.' Additionally: 'Note: Drugs prescribed for weight management (e.g., obesity or overweight) in the absence of another evidence-supported indication are not currently covered.' Drugs prescribed for only weight management (overweight or obesity) are NOT currently covered per Table 3 note.

Policy note: Wegovy (semaglutide injection) is explicitly not covered for adults when indicated solely for weight loss/obesity/overweight without an evidence-supported indication such as established CV disease or MASH. This applies to the Oregon Health Plan (Oregon Medicaid). Note: pediatric weight loss (EPSDT) coverage via Wegovy injection is potentially available for children 12 years and older under the EPSDT pathway described in the approval criteria, but the document does not establish separate formal criteria for Wegovy specifically in this pediatric context (the EPSDT pathway covers FDA-approved drugs for weight management generally). The explicit adult exclusion is clear.

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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If weight loss isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Oregon Medicaid about a formulary exception.

Questions people ask
Does Oregon Medicaid cover Wegovy?
No. Oregon Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.
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.