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Tennessee Medicaid

Does Tennessee Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Tennessee Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.

Policy document

  • 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 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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Questions people ask
Does Tennessee Medicaid cover Wegovy?
Yes. Tennessee Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
What does Tennessee Medicaid require to renew Wegovy?
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.
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.