Virginia Medicaid coverage for Wegovy (Liver Disease (MASH))

What you need to qualify

• Confirmed MASH diagnosis

Documentation to bring

• GLP-1 Receptor Agonists for Metabolic Dysfunction-Associated Steatohepatitis SA Form

Policy note: The document references a separate SA form titled 'GLP-1 Receptor Agonists for Metabolic Dysfunction-Associated Steatohepatitis SA Form'. Detailed clinical criteria are contained in the referenced fax form and not reproduced in this PDL document. Authorization length is 'as indicated on fax form'. The document notes 'The selected GLP-1 Receptor Agonist is injectable brand Wegovy'.

Policy effective April 1, 2026 · verified June 4, 2026 · source: VAmed-PDL-List-Criteria-20260401-v6.pdf