Medicaid
Covered (preferred drug)What you need to qualify
- Age 18 and older
- Trial of metformin for at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"])
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
Adult initial approval for T2DM
All of:
- Age >= 18 years
- Documented diagnosis of T2DM
- Trial and failure (e.g., A1C goal not met), intolerance, or contraindication to metformin (90-day lookback for paid claims in history)
- Documentation of baseline A1C within the previous 3 months
- Requested dose does not exceed the maximum FDA-approved dose for treatment of diabetes mellitus
Documentation to bring
- Documented diagnosis of T2DM
- Evidence of metformin trial and failure, intolerance, or contraindication (90-day lookback for paid claims in history)
- Baseline A1C lab result within the previous 3 months
- Confirmation that requested dose does not exceed maximum FDA-approved dose for diabetes
Approval and renewal
- Initial approval: 6 months
- Renewal: every 12 months
- To renew, the plan looks for improvement in A1C and Reduction in A1C from baseline, OR A1C goal achieved, OR improvement in fasting blood glucose levels. Supporting documentation within the previous 3 months required. Patient must not have experienced any treatment-restricting adverse events.
Policy note: Ozempic is listed as a preferred product alongside Trulicity and Victoza. Non-preferred products (Mounjaro and others) require a trial or failure of preferred products, or rationale why preferred products cannot be used. The 90-day metformin lookback is based on paid claims history.
Policy effective May 1, 2026 · verified June 4, 2026 · source: SCRx_PAcriteria_GLP1s.pdf