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