Does Wisconsin Medicaid cover Ozempic?

Quick answer · Type 2 Diabetes

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

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

Policy last verified June 3, 2026. Source: Pa policy. How we verify this data.

Card and program names on file in Wisconsin

Select a name to read the Wisconsin 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 with requirements

What you need to qualify

  • A1C of 6.5% or higher
  • Diagnosis documented with a code
  • Prior trial of 2 other GLP-1 medications (preferred GLP-1 agents (at least 2)) for at least 90 days
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Non-preferred GLP-1 approval for T2DM

All of:

  • Drug is prescribed consistent with FDA-approved labeling
  • Member has type 2 diabetes mellitus
  • HbA1c measured within the past 6 months
  • If not currently on a GLP-1 agent: most recent HbA1c >= 6.5%
  • For at least 2 preferred GLP-1 agents: documented trial at maximum dose for >= 3 consecutive months with unsatisfactory glycemic response, OR clinically significant adverse drug reaction

Documentation to bring

  • Completed and signed Prior Authorization Drug Attachment for Hypoglycemics, GLP-1 Agents (Form F-00238)
  • Completed PA/RF (Prior Authorization Request Form, F-11018)
  • Copy of member's current medical records documenting the medical condition being treated
  • Details regarding previous GLP-1 medication use (at least 2 preferred GLP-1 agents trialed)
  • Member's current treatment plan
  • Member's current HbA1c lab report (within past 6 months)
  • For step therapy failure pathway: HbA1c measured after member has been taking the maximum dose of a preferred agent for at least 3 consecutive months
  • For adverse reaction pathway: documentation of clinically significant adverse drug reaction with preferred GLP-1 agent(s)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • To renew, the plan looks for improvement in A1C and Member must have been adherent with prescribed treatment regimen AND have a reduction in HbA1c compared to baseline prior to initiation of the non-preferred GLP-1 agent.

Not covered when

  • Nonadherence to previous GLP-1 treatment is not valid criteria
  • Member's fear of needles is not valid criteria
  • Member's or prescriber's preference for an oral agent is not valid criteria
  • Member's or prescriber's preference for the non-preferred GLP-1 agent is not valid criteria
  • Member's or prescriber's preference for less frequent dosing schedule is not valid criteria
  • Type 1 diabetes

Policy note: This is a Wisconsin ForwardHealth (Medicaid) policy. The document covers non-preferred GLP-1 agents as a class; preferred GLP-1 agents require only a valid diagnosis code on claims without a separate PA. The A1C >= 6.5% threshold applies only if the member is NOT currently on a GLP-1 agent; members already on a GLP-1 agent do not have a specific A1C threshold stated for switching. Initial PA approved for up to 183 days (~6 months); renewal approved up to 365 days. Step therapy requires trial and failure or adverse reaction with at least 2 preferred GLP-1 agents. The document does not name specific preferred vs. non-preferred agents; Ozempic is classified as non-preferred based on document context.

verified June 3, 2026 · source: Pa policy

Full Wisconsin Medicaid coverage page for Ozempic

Other medications under Wisconsin 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.