You can qualify through any one of these.
Initial approval — Wegovy for MASH (non-preferred)
All of:
- Prescribed by or in consultation with a hepatologist or gastroenterologist
- Diagnosis of MASH with moderate to advanced liver fibrosis (stage F2 or F3) confirmed by approved method
- No significant alcohol use (defined as >1 drink/day for natal females or >2 drinks/day for natal males) and no alcohol dependence
- Used in combination with optimized pharmacotherapy for established comorbid diseases (CVD, dyslipidemia, diabetes, hypertension) per current consensus guidelines unless contraindicated or not tolerated
- Used in combination with lifestyle changes and behavioral modifications
- Age-appropriate per FDA labeling, compendia, or peer-reviewed literature
- No contraindication to the prescribed drug
- History of therapeutic failure of, OR contraindication to, OR intolerance to the maximum FDA-approved dose of Ozempic (semaglutide)
Plus any one of:
- Liver biopsy within the past 3 years confirming F2-F3 fibrosis
- FIB-4 index >= 1.3 (age <65) or >= 2.0 (age >=65) PLUS one of: liver stiffness by VCTE (FibroScan), MRE, shear wave elastography (SWE), or Enhanced Liver Fibrosis (ELF) score
Initial approval — Wegovy 2.4 mg for MASH (non-preferred, strength-specific)
All of:
- All standard MASH criteria above met
Plus any one of:
- Dose titration to semaglutide 2 mg completed AND medical reason supporting need for 2.4 mg dose
- History of therapeutic failure of Ozempic (semaglutide) at maximum FDA-approved dose
Initial approval — addition of Wegovy to Rezdiffra (resmetirom) for MASH
All of:
- All standard MASH criteria above met
- Failed to show improvement in liver fibrosis after >= 12 months of Rezdiffra (resmetirom)
Policy effective January 1, 2026 · verified June 4, 2026 · source: mab2025112403.pdf