Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)›
Applies to Medicaid plans.
Covered with requirements
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: V Amed Pdl List Criteria 20260401 V6
· View policy document (PDF)
Yes. Virginia Medicaid covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.
Card and program names on file in Virginia
These names map to Virginia Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.