Does Florida Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

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

The card and program names below are mapped to Florida 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 June 16, 2025. Source: Glucagon-like%20Peptide-1%20(GLP-1)%20Receptor%20Agonist%20and%20Related%20Agents%2003.12.2026.pdf. How we verify this data.

Card and program names on file in Florida

Select a name to read the Florida Medicaid policy for Ozempic. 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.

Ozempic for Type 2 Diabetes

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

Full Florida Medicaid coverage page for Ozempic

Other medications under Florida Medicaid

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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.