Medicaid
Covered with requirementsWhat you need to qualify
- Prior trial of another GLP-1 medication (Exenatide, Mounjaro, Rybelsus, Trulicity, and Victoza) for at least 84 days
Qualification pathways
You can qualify through any one of these.
Non-preferred GLP-1 for Type 2 Diabetes — Step Through Preferred
All of:
- Diagnosis of Type 2 Diabetes Mellitus
Plus any one of:
- Documented side effect with a preferred GLP-1 product
- Documented allergy to a preferred GLP-1 product
- Documented contraindication to a preferred GLP-1 product
- Treatment failure of a preferred GLP-1 product (defined as <1% reduction in HbA1c after 12 weeks at maximally tolerated dose)
Documentation to bring
- Documentation of Type 2 Diabetes Mellitus diagnosis
- Documentation of side effect, allergy, contraindication, or treatment failure with a preferred GLP-1 product
Quantity limits
- all strengths — 9 mL/84 days (84-day)
Policy note: Ozempic is a non-preferred agent requiring PA. Patient must have documented side effect, allergy, contraindication, or treatment failure with a preferred GLP-1 product. Treatment failure is defined as <1% reduction in HbA1c after 12 weeks at the maximally tolerated dose. Prior_glp1_trial_duration_days set to 84 based on the 12-week treatment failure definition.
Policy effective April 17, 2026 · verified June 4, 2026 · source: Vermont-PDL-20260417.pdf