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Tennessee Medicaid

Does Tennessee Medicaid cover Wegovy?

Yes. Tennessee Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy documents

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial Approval — Pediatric (< 18 years)

All of:

  • Age ≥ 12 years
  • Treatment is for management of obesity
  • BMI ≥ 95th percentile standardized for age and sex (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Initial Approval — Adult (≥ 18 years), BMI > 30

All of:

  • Age ≥ 18 years
  • Treatment is for management of obesity
  • BMI > 30 kg/m² (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Initial Approval — Adult (≥ 18 years), BMI > 27 with comorbidity

All of:

  • Age ≥ 18 years
  • Treatment is for management of obesity
  • BMI > 27 kg/m² (documented via medical records/chart notes)
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other FDA-approved obesity/weight loss medications
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Diabetes
  • Coronary heart disease
  • MASH/NASH
  • Obstructive sleep apnea

Renewal

All of:

  • Continued participation in complementary nutritional and lifestyle changes
  • Medication will not be used in combination with other obesity/weight loss medications
  • Documentation of ≥ 5% weight loss from baseline body weight

Documentation to bring

  • Medical records (e.g., chart notes) documenting BMI ≥ 95th percentile for age and sex (patients < 18 years)
  • Medical records (e.g., chart notes) documenting BMI > 30 kg/m² (adults ≥ 18 years, BMI-only pathway)
  • Medical records (e.g., chart notes) documenting BMI > 27 kg/m² with a weight-related comorbidity (adults ≥ 18 years, comorbidity pathway)
  • Prescriber attestation that patient is participating in complementary nutritional and lifestyle changes
  • At renewal: medical records (e.g., chart notes) documenting weight loss of ≥ 5% of baseline body weight

Quantity limits

  • all strengths — 4 injections/month

Approval and renewal

  • Renewal: Documentation of ≥ 5% weight loss from baseline body weight. Continued participation in complementary nutritional and lifestyle changes required. Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication.

Not covered when

  • Personal or immediate family history of medullary thyroid carcinoma (MTC)
  • Personal or immediate family history of multiple endocrine neoplasia type 2 (MEN2)
  • Concurrent use of other FDA-approved obesity/weight loss medications
  • Concurrent use of another GLP-1 receptor agonist

Policy note: PDL Status: Preferred (P). Document is TennCare PDL (Tennessee Medicaid). Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication. The lifestyle program attestation is required (prescriber-attested participation), not merely FDA label language — set requires lifestyle program: true. The document does not specify separate quantity limits by dose strength; a single limit of 4 injections/month applies to all strengths.

Policy effective June 1, 2026 · verified June 3, 2026 · source: Criteria Pdl · View policy document (PDF)

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Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for CV Risk Reduction

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient is 18 years of age or older
  • Initial BMI ≥ 27 kg/m2 documented in medical records
  • Patient is on optimized guideline-directed therapy including beta-blockers, RAS inhibitors, and lipid-lowering agents unless contraindicated
  • Prescriber attests patient is participating in complementary nutritional and lifestyle changes
  • Will not be used concomitantly with DPP-4 inhibitors
  • Will not be co-administered with another GLP-1 receptor agonist

Plus any one of:

  • Prior myocardial infarction
  • Prior stroke (ischemic and hemorrhagic)
  • Symptomatic peripheral arterial disease as evidenced by intermittent claudication with ankle brachial index < 0.85, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease

Documentation to bring

  • Medical documentation (e.g., chart notes) of initial BMI ≥ 27 kg/m2
  • Medical documentation of qualifying CVD event: prior MI, prior stroke, or symptomatic PAD (intermittent claudication with ABI < 0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • Documentation of current optimized GDMT use (beta-blockers, RAS inhibitors, lipid-lowering agents) or claims history, unless contraindicated
  • Prescriber attestation that patient is participating in complementary nutritional and lifestyle changes

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — 4 injectors

Approval and renewal

  • Renewal: Positive clinical response required: patient has not had a major cardiovascular event within the past 12 months, OR decreased body weight or waist circumference from baseline, OR decreased blood pressure, total cholesterol, LDL, or triglyceride levels from baseline. GDMT requirement IS re-verified at renewal. Lifestyle attestation IS re-verified at renewal. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal.

Not covered when

  • Concomitant use of DPP-4 inhibitors
  • Co-administration with another GLP-1 receptor agonist (e.g., Byetta, Ozempic, Victoza)

Policy note: Qualifying PAD criteria include: intermittent claudication with ABI < 0.85, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. GDMT must include beta-blockers, RAS inhibitors, and lipid-lowering agents unless contraindicated, supported by medical documentation or claims history. The document does not explicitly exclude patients with diabetes from this indication. Quantity limit is 4 injectors per 28 days.

Policy effective June 1, 2026 · verified June 3, 2026 · source: Criteria Pdl · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for NASH/MASH

All of:

  • Patient is 18 years of age or older
  • Diagnosis of NASH or MASH
  • Fibrosis stage F2 or F3 confirmed by an approved diagnostic method
  • Prescriber attests patient is participating in a supervised comprehensive weight management program
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Will not be used concomitantly with DPP-4 inhibitors
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Plus any one of:

  • Fibrosis confirmed by FibroScan
  • Fibrosis confirmed by Fibrosis-4 index (FIB-4)
  • Fibrosis confirmed by Magnetic Resonance Elastography (MRE)
  • Fibrosis confirmed by liver biopsy

Documentation to bring

  • Medical records (e.g., chart notes) confirming diagnosis of NASH or MASH
  • Medical records confirming fibrosis stage F2 or F3 via FibroScan, FIB-4, MRE, or liver biopsy
  • Prescriber attestation that patient is participating in a supervised comprehensive weight management program
  • Documentation of prescriber specialty (gastroenterologist or hepatologist) or consultation note
  • Documentation that patient has no personal or immediate family history of medullary thyroid carcinoma or MEN2

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — 4 injectors

Approval and renewal

  • Renewal: Positive clinical response required: improvement in NASH/MASH disease symptoms documented in recent medical records (chart notes and/or labs).

Not covered when

  • Personal or immediate family history of medullary thyroid carcinoma or MEN2
  • Concomitant use of DPP-4 inhibitors
  • Co-administration with another GLP-1 receptor agonist

Policy note: Document uses both NASH and MASH terminology interchangeably. Fibrosis stage must be F2 or F3 (not F1, F4, or cirrhotic). No specific lookback periods stated for diagnostic tests. Specialist requirement: prescribed by or in consultation with a gastroenterologist or hepatologist. Renewal only requires positive clinical response documentation; specialist, BMI, and fibrosis confirmation requirements are not explicitly re-verified at renewal.

Policy effective June 1, 2026 · verified June 3, 2026 · source: Criteria Pdl · View policy document (PDF)

Open on its own page →

Questions people ask
Does Tennessee Medicaid cover Wegovy?
Yes. Tennessee Medicaid covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
What does Tennessee Medicaid require to renew Wegovy?
Weight Loss — Applies to Medicaid plans. Documentation of ≥ 5% weight loss from baseline body weight. Continued participation in complementary nutritional and lifestyle changes required. Patients not meeting renewal criteria may be approved for up to one month to allow for titration off medication. Heart Disease Risk Reduction — Applies to Medicaid plans. Positive clinical response required: patient has not had a major cardiovascular event within the past 12 months, OR decreased body weight or waist circumference from baseline, OR decreased blood pressure, total cholesterol, LDL, or triglyceride levels from baseline. GDMT requirement IS re-verified at renewal. Lifestyle attestation IS re-verified at renewal. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal. Liver Disease (MASH) — Applies to Medicaid plans. Positive clinical response required: improvement in NASH/MASH disease symptoms documented in recent medical records (chart notes and/or labs).
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Tennessee Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth, Fallon Health Plan

All insurance plans · All medications

Summary of Tennessee Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.