Does Ohio Medicaid cover Wegovy?

Quick answer · Weight Loss

Ohio Medicaid does not cover it for weight loss on Medicaid.

The card and program names below are mapped to Ohio 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 February 4, 2025. Source: Pa policy. How we verify this data.

Card and program names on file in Ohio

Select a name to read the Ohio 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

Not covered

Per Ohio Administrative Code (OAC) 5160-9-03, drugs used for the treatment of obesity are not covered by the Ohio Department of Medicaid.

Policy note: Explicitly excluded by OAC 5160-9-03: 'drugs used for the treatment of obesity are not covered by the Ohio Department of Medicaid.'

Policy effective February 4, 2025 · verified June 4, 2026 · source: Pa policy

Wegovy for Heart Disease Risk Reduction

Medicaid

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • Diagnosis documented with a code
  • Established cardiovascular disease (MI, stroke, and PAD)
  • On guideline-directed medical therapy (antiplatelet_agent, aspirin, platelet_aggregation_inhibitor, statin, ezetimibe, fibrate, PCSK9_inhibitor, beta_blocker, ACE_inhibitor, and ARB)

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction (MACE) — Initial Approval

All of:

  • Age >= 45 years
  • Diagnosis is reduction of Major Adverse Cardiovascular Events (MACE)
  • BMI >= 27 kg/m²
  • History of Type 1 or Type 2 diabetes mellitus
  • At least one qualifying established cardiovascular event (MI, stroke, or symptomatic PAD)
  • Receiving standard CV therapy (antiplatelet agent, lipid-lowering therapy, and/or antihypertensive) OR documented inability to take standard CV therapy due to side effects or medical condition

Plus any one of:

  • History of myocardial infarction (heart attack)
  • History of stroke
  • Symptomatic Peripheral Artery Disease: intermittent claudication with ABI < 0.85 at rest
  • Symptomatic Peripheral Artery Disease: peripheral arterial revascularization procedure (endarterectomy, angioplasty, stenting)
  • Symptomatic Peripheral Artery Disease: amputation due to ASCVD

Documentation to bring

  • ICD-10 diagnosis code(s)
  • Patient age >= 45 years
  • Confirmation that diagnosis is for MACE reduction
  • Documentation of BMI >= 27 kg/m²
  • Documentation of history of diabetes (Type 1 or Type 2)
  • Documentation of qualifying CV event: MI with date, OR stroke with date, OR symptomatic PAD (type and date)
  • List of current standard CV therapy medications OR explanation of why patient cannot take standard CV therapy

Not covered when

  • Patients under age 21 must use EPSDT pathway (Standard PA Fillable form) per OAC Rule 5160-1-14

Policy note: Per Ohio Administrative Code (OAC) 5160-9-03, drugs used for the treatment of obesity are NOT covered by the Ohio Department of Medicaid. This PA form is specifically for the MACE reduction indication only. Notably, the GDMT requirement can be satisfied with documentation that the patient is unable to take standard CV therapy due to side effects or another medical condition. The diabetes history requirement (Q4) includes both Type 1 and Type 2 diabetes — this mirrors the SELECT trial population and does NOT exclude diabetes. This differs from the FDA labeling population (overweight/obese without diabetes) used for Wegovy's CV indication more broadly; here diabetes is REQUIRED as per the PA form.

Policy effective February 4, 2025 · verified June 4, 2026 · source: Pa policy

Full Ohio Medicaid coverage page for Wegovy

Other medications under Ohio 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.