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Pennsylvania Medicaid

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

Yes. Pennsylvania Medicaid covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. 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: 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.

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)

Documentation to bring

  • Documentation of specialist prescribing or consultation (hepatologist or gastroenterologist)
  • Documentation of MASH diagnosis with F2-F3 fibrosis: liver biopsy within past 3 years OR FIB-4 ≥ 1.3 (<65 yrs) or ≥ 2.0 (≥65 yrs) plus VCTE/MRE/SWE/ELF result
  • Documentation of no significant alcohol use (≤1 drink/day natal female; ≤2 drinks/day natal male) and no alcohol dependence
  • Documentation of optimized pharmacotherapy for comorbid diseases or reason contraindicated/not tolerated
  • Documentation of therapeutic failure of Ozempic at maximum FDA-approved dose, OR contraindication or intolerance to Ozempic (with chart documentation of troubleshooting attempts over at least 1 month if intolerance-based)
  • For Wegovy 2.4 mg: documentation that dose titration to semaglutide 2 mg has been completed and medical reason for 2.4 mg dose — OR therapeutic failure of Ozempic at max dose
  • If currently on Rezdiffra (resmetirom): documentation of failure to improve liver fibrosis after ≥ 12 months of Rezdiffra
  • Documentation of age-appropriateness per FDA labeling, compendia, or peer-reviewed literature
  • Documentation of no contraindication to the prescribed drug
  • If therapeutic duplication: documentation of intent to transition or medical reason for concomitant use

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Renewal requires: (1) prescribed by or in consultation with hepatologist or gastroenterologist; (2) no significant alcohol use; (3) optimized pharmacotherapy for comorbid diseases; (4) continued lifestyle changes and behavioral modifications; (5) step-therapy requirement (therapeutic failure/contraindication/intolerance to Ozempic max dose). If on GLP-1 for ≥ 1 year, must document: resolution of steatohepatitis and improvement or no worsening of liver fibrosis, OR improvement of liver fibrosis and no worsening of steatohepatitis. If currently taking Rezdiffra (resmetirom) and adding GLP-1: must have failed to show improvement in liver fibrosis after ≥ 12 months of Rezdiffra. Baseline fibrosis staging not re-confirmed at renewal per renewal guidelines.

Not covered when

  • Cirrhotic MASH excluded (noncirrhotic MASH only)
  • Significant alcohol use (>1 drink/day natal female or >2 drinks/day natal male) or alcohol dependence is an exclusion
  • Overweight/obesity treatment indication excluded
  • Saxenda (liraglutide) not covered for any indication

Policy note: MASH fibrosis confirmation: liver biopsy must be within past 3 years (36 months). For FIB-4 pathway, FIB-4 cutoff is age-stratified: ≥1.3 for patients <65 years old, ≥2.0 for patients ≥65 years old. Second-line imaging/test required alongside FIB-4: VCTE (FibroScan), MRE, SWE, or ELF score. Alcohol limits are stated in drinks per day, not grams (policy does not specify gram equivalents). Concomitant Rezdiffra requires prior 12-month trial failure of resmetirom before adding GLP-1. At renewal, if on GLP-1 for ≥1 year, must document liver fibrosis/steatohepatitis response. All non-OSA/non-MASH/non-CV non-diabetes indications require 6-month prior lifestyle trial; MASH requires only concurrent lifestyle modification. Approval up to 6 months per cycle. Prescriptions limited to 1-month supply per fill.

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 Wegovy?
Yes. Pennsylvania 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 Pennsylvania Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Pennsylvania Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. Renewal requires: (1) prescribed by or in consultation with hepatologist or gastroenterologist; (2) no significant alcohol use; (3) optimized pharmacotherapy for comorbid diseases; (4) continued lifestyle changes and behavioral modifications; (5) step-therapy requirement (therapeutic failure/contraindication/intolerance to Ozempic max dose). If on GLP-1 for ≥ 1 year, must document: resolution of steatohepatitis and improvement or no worsening of liver fibrosis, OR improvement of liver fibrosis and no worsening of steatohepatitis. If currently taking Rezdiffra (resmetirom) and adding GLP-1: must have failed to show improvement in liver fibrosis after ≥ 12 months of Rezdiffra. Baseline fibrosis staging not re-confirmed at renewal per renewal guidelines.
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, Ozempic, Zepbound

Wegovy under other plans: Capital BlueCross, Highmark, Independence Blue Cross, Alabama 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.