Priority Health

Does Priority Health cover Ozempic?

Quick answer · Type 2 Diabetes

Priority Health covers Ozempic for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered (preferred drug). No additional clinical requirements listed.

Last verified June 10, 2026. Policy effective May 1, 2025. Source: medicaid-rx-pa-criteria.pdf. How we verify this data →

Check your card for your exact plan →

Ozempic for Type 2 Diabetes

What Priority Health requires, by plan type. Open this indication on its own page →

Medicaid

Covered (preferred drug)

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

Preferred agent — clinical PA criteria

All of:

  • Diagnosis of type 2 diabetes
  • Discontinuation of other GLP-1 agonists
  • Discontinuation of DPP-4 inhibitors

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Confirmation of discontinuation of other GLP-1 agonists
  • Confirmation of discontinuation of DPP-4 inhibitors

Approval and renewal

  • Initial approval: 12 months

Policy note: Ozempic is listed as a preferred agent in the Incretin Mimetics class. Preferred agent PA criteria require T2DM diagnosis plus discontinuation of other GLP-1 agonists and DPP-4 inhibitors. Approval duration is up to 1 year.

Policy effective May 1, 2025 · verified June 10, 2026 · source: medicaid-rx-pa-criteria.pdf

Why Ozempic requests get denied by Priority Health

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.

Frequently asked questions

Does Priority Health cover Ozempic?
Priority Health covers Ozempic for type 2 diabetes with prior authorization on Medicaid.
How long does a Ozempic approval last with Priority Health?
Initial approvals last 12 months.
How current is this information?
This page reflects Priority Health's written policy as of May 1, 2025, last verified against the source document on June 10, 2026.

Other medications under Priority Health

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Priority Health's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.