Oregon Medicaid coverage for Wegovy (Weight Loss)

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%20Medicaid%20PA%20Criteria%20Guide%20-%20June%201%2C%202026.pdf