Does Colorado Medicaid cover Wegovy?

Quick answer · Weight Loss

Colorado Medicaid covers Wegovy for weight loss with prior authorization on Medicaid.

The card and program names below are mapped to Colorado Medicaid in our records. Coverage depends on the reason for treatment and the requirements in the policy.

Policy last verified June 4, 2026. Policy effective March 1, 2023. Source: 04-01-26%20PDL%20V1.pdf. How we verify this data.

Card and program names on file in Colorado

Select a name to read the Colorado Medicaid policy for Wegovy. These are names we recognize, including older names and spelling variants; this is not a list of plans currently accepting members.

Don't see your card name? Check your card or call the pharmacy-benefit number on your card. If you also have Medicare, confirm which plan handles this prescription.

Wegovy for Weight Loss

Medicaid

Covered with requirements

What you need to qualify

Age 12 and older
BMI of 30 or higher
BMI of 27 or higher with a weight-related condition (HTN, T2DM, and dyslipidemia)

Qualification pathways

You can qualify through any one of these.

Adult weight loss (age >= 18)

All of:

Age >= 18 years
BMI >= 30 kg/m2 with no risk factors OR BMI >= 27 kg/m2 with at least one weight-related comorbid condition (hypertension, T2DM, or dyslipidemia)
Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
No concurrent use of any other weight loss drug(s)
Patient's baseline weight (in kg) submitted at time of request

Pediatric weight loss (age 12-17)

All of:

Age 12-17 years
BMI >= 30 kg/m2 AND body weight above 60 kg
Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
No concurrent use of any other weight loss drug(s)
Patient's baseline weight (in kg) submitted at time of request

Documentation to bring

Baseline BMI documentation (>= 30 kg/m2 without comorbidities, or >= 27 kg/m2 with qualifying comorbidity; >= 30 kg/m2 and weight > 60 kg for ages 12-17)
Patient's baseline body weight in kg
Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
Documentation that no contraindications exist, or prescriber attestation that benefits outweigh risks
Confirmation of no concurrent use of other weight loss drugs

Quantity limits

all strengths — Per FDA-approved label

Approval and renewal

Initial approval: 6 months
Renewal: every 12 months
To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, and Adults (>=18): at least 5% weight loss during initial approval period. Pediatric (12-17): at least 5% reduction in baseline BMI during initial approval period. Subsequent renewals (beyond 18 months) also require documentation that patient maintains weight loss achieved during the initial approval period. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

No concurrent use of any other weight loss drug(s)
No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: Policy effective date listed for Anti-Obesity Medications section is March 2023; the Weight Management Agents section (which covers MACE, MASH, and OSA indications) is dated May 2026. Initial approval is 6 months; renewal is 12 months. After lapses in therapy, additional trials may be approved if initial criteria are met. Subsequent renewals beyond 18 months require meeting all renewal criteria plus documentation of maintained weight loss. The Anti-Obesity Medications PDL page lists Wegovy as a covered drug requiring PA.

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Wegovy for Heart Disease Risk Reduction

Medicaid

Covered with requirements

What you need to qualify

Prescribed by or in consultation with a specialist
Established cardiovascular disease

Qualification pathways

You can qualify through any one of these.

MACE risk reduction

All of:

Requested drug is FDA approved for MACE
Diagnosis of obesity or overweight
Patient meets age limit in FDA-approved label
Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
No concurrent use of any other GLP-1 receptor agonist
Diagnosis of established cardiovascular (CV) disease
Documentation of management of CV risk factors
Requested agent prescribed by or in consultation with a cardiologist

Documentation to bring

Confirmation that requested drug is FDA approved for MACE indication
Documentation of diagnosis of obesity or overweight
Documentation of established cardiovascular (CV) disease
Documentation of management of CV risk factors
Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
Confirmation of no concurrent use of any other GLP-1 receptor agonist
Prescription or consultation note from a cardiologist

Quantity limits

all strengths — Per FDA-approved label

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Renewal criteria same as initial (up to 12 months per approval cycle). No separate continuation outcome requirements specified for MACE indication beyond re-meeting initial criteria.

Not covered when

No concurrent use of any other GLP-1 receptor agonist

Policy note: This criteria is from the Weight Management Agents section dated May 2026. The policy requires established CV disease and cardiologist involvement. Management of CV risk factors is required but specific GDMT medications are not enumerated. Approval is up to 12 months (initial and renewal per cycle).

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Wegovy for Liver Disease (MASH)

Medicaid

Covered with requirements

What you need to qualify

Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH with moderate to advanced fibrosis

All of:

Requested drug is FDA approved for MASH
Patient meets age limit in FDA-approved label
Documentation of initiation of or ongoing reduced calorie diet OR ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity unless medically contraindicated by comorbidity
No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks
No concurrent use of any other GLP-1 receptor agonist
Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)
Moderate to advanced liver fibrosis consistent with stages F2 to F3
Requested agent prescribed by or in consultation with a gastroenterologist or hepatologist

Documentation to bring

Confirmation that requested drug is FDA approved for MASH indication
Documentation of diagnosis of noncirrhotic MASH
Documentation of liver fibrosis stage consistent with F2 to F3 (moderate to advanced fibrosis)
Documentation of initiation of or ongoing reduced calorie diet OR documentation of ongoing care of a registered dietitian nutritionist
Documentation of initiation of or ongoing increased physical activity (or documentation of medical contraindication to physical activity)
Documentation that no contraindications exist, or prescriber attestation that benefits outweigh risks
Confirmation of no concurrent use of any other GLP-1 receptor agonist
Prescription or consultation note from a gastroenterologist or hepatologist

Quantity limits

all strengths — Per FDA-approved label

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Renewal criteria same as initial (up to 12 months per approval cycle). No separate continuation outcome requirements specified for MASH indication beyond re-meeting initial criteria.

Not covered when

Cirrhotic MASH (must be noncirrhotic)
No concurrent use of any other GLP-1 receptor agonist
No contraindications (disease state or current therapy) unless prescriber documents benefits outweigh risks

Policy note: This criteria is from the Weight Management Agents section dated May 2026. The document requires F2-F3 fibrosis (moderate to advanced) and noncirrhotic MASH. Specific fibrosis confirmation methods (biopsy, FibroScan, FIB-4, etc.) are not enumerated in this policy. Specialist (gastroenterologist or hepatologist) involvement is required.

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Full Colorado Medicaid coverage page for Wegovy

Other medications under Colorado Medicaid

All insurance plans · All medications

This page summarizes written Medicaid policies on file. It is not a guarantee of coverage or medical advice. Confirm your current benefits and prior-authorization requirements with your plan.