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Pennsylvania Medicaid

Does Pennsylvania Medicaid cover Ozempic for Type 2 Diabetes?

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

Policy document

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Pennsylvania

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

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Preferred GLP-1 for diabetes — initial and renewal

Plus any one of:

  • Diagnosis of diabetes
  • History of an antidiabetic drug (excluding metformin, SGLT-2 inhibitors, and GLP-1 receptor agonists) within the last 120 days

Documentation to bring

  • Documentation of diabetes diagnosis OR history of qualifying antidiabetic drug use within last 120 days
  • Documentation that beneficiary is age-appropriate per FDA labeling, compendia, or peer-reviewed literature
  • Documentation of no contraindication to the prescribed drug
  • Documentation addressing therapeutic duplication if a recent paid claim for another GLP-1 or DPP-4 inhibitor exists

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Renewal requires: diagnosis of diabetes OR history of antidiabetic drug (excluding metformin, SGLT-2 inhibitors, and GLP-1s) within last 120 days. No weight-loss or BMI criteria re-checked at renewal since obesity indication is excluded.

Not covered when

  • Saxenda (liraglutide) is not covered for any indication
  • Overweight and obesity treatment indications are excluded for all GLP-1 receptor agonists

Policy note: Ozempic is a preferred GLP-1 receptor agonist for diabetes on the Pennsylvania MA Statewide PDL. Non-preferred GLP-1s for diabetes require: (1) diabetes diagnosis, (2) therapeutic failure of, contraindication to, or intolerance to the maximum FDA-approved dose of preferred GLP-1(s) approved for the beneficiary's diagnosis, and (3) the requested drug must be FDA-approved for diabetes. All prescriptions are limited to a one-month supply per fill. Therapeutic duplication rules apply: if a recent paid claim exists for another GLP-1 or DPP-4 inhibitor, must document intent to transition off one drug or a medical reason for concomitant use supported by literature or guidelines. A physician reviewer may approve requests that do not meet standard guidelines if deemed medically necessary.

Policy effective January 1, 2026 · verified June 4, 2026 · source: Mab2025112403 · View policy document (PDF)

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Questions people ask
Does Pennsylvania Medicaid cover Ozempic?
Yes. Pennsylvania 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 Pennsylvania Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Pennsylvania Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Renewal requires: diagnosis of diabetes OR history of antidiabetic drug (excluding metformin, SGLT-2 inhibitors, and GLP-1s) within last 120 days. No weight-loss or BMI criteria re-checked at renewal since obesity indication is excluded.
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.

Card and program names on file in Pennsylvania

These names map to Pennsylvania Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Pennsylvania Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Capital BlueCross, Independence Blue Cross, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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