Medicaid
Covered (preferred drug)What you need to qualify
- Age 18 and older
- A1C of 6.5% or higher
- 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.
Initial approval for Type 2 Diabetes (Preferred Agent)
All of:
- Patient is >= 18 years of age
- Diagnosis of type 2 diabetes mellitus
- HbA1c >= 6.5% measured within the past 6 months (documentation required)
- Trial and failure of metformin within the past 2 years, unless contraindicated or patient is intolerant (documentation required)
Documentation to bring
- HbA1c lab result >= 6.5% within the past 6 months
- Documentation of metformin trial and failure within the past 2 years, OR documentation of contraindication or intolerance to metformin
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
- To renew, the plan looks for improvement in A1C and Documentation of improved clinical response (e.g., decline in HbA1c); patient has not experienced any treatment-restricting adverse effects; dosing is appropriate per labeling or supported by compendia. Initial BMI, metformin trial, and preferred agent step therapy are not re-verified at continuation.
Policy note: Ozempic is listed as a preferred agent requiring Clinical Prior Authorization. The metformin trial lookback window is 2 years. A1C lookback window is 6 months. Non-preferred agents (Rybelsus) require an additional step of trial and failure/adverse reaction/contraindication to preferred GLP-1s. Rybelsus (oral semaglutide) is a non-preferred agent in this policy; though it contains semaglutide, it does not meet the in-scope brand criteria for a separate criteria entry as it is not Ozempic or Wegovy.
Policy effective June 16, 2025 · verified June 4, 2026 · source: Glucagon-like%20Peptide-1%20(GLP-1)%20Receptor%20Agonist%20and%20Related%20Agents%2003.12.2026.pdf