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Washington Medicaid

Does Washington Medicaid cover Ozempic?

Yes. Washington Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Washington

Full requirements: Ozempic for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Non-preferred agent (Ozempic) for T2DM — initial approval

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 18 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • History of failure (inability to achieve HbA1c < 7%) on metformin at maximum or highest tolerated dose for a minimum of 90 continuous days (unless not tolerated, contraindicated, or clinically inappropriate)
  • History of failure (inability to achieve HbA1c < 7%) on liraglutide at maximum or highest tolerated dose for a minimum of 90 continuous days (unless not tolerated, contraindicated, or clinically inappropriate)

Documentation to bring

  • Diagnosis of type 2 diabetes OR HbA1c lab result ≥ 6.5 within the last 12 months
  • Documentation of patient age (≥ 18 years)
  • Documentation confirming drug will not be combined with another GLP-1 agonist or DPP4 inhibitor
  • Documentation of metformin trial at maximum or highest tolerated dose for ≥ 90 continuous days with inadequate response (HbA1c not achieving <7%), OR documentation of intolerance/contraindication/clinical inappropriateness
  • Documentation of liraglutide trial at maximum or highest tolerated dose for ≥ 90 continuous days with inadequate response (HbA1c not achieving <7%), OR documentation of intolerance/contraindication/clinical inappropriateness

Quantity limits

  • 0.25mg/0.5mL, 0.5mg/0.5mL, 1mg/0.5mL — 3 mL per 28 days (2 mg/3 mL pen injector)
  • 1mg/0.5mL (4mg/3mL pen) — 3 mL per 28 days (4 mg/3 mL pen injector)
  • 2mg/0.5mL (8mg/3mL pen) — 3 mL per 28 days (8 mg/3 mL pen injector)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. BMI and prior therapy step requirements are NOT re-verified at continuation.

Not covered when

  • Concurrent use with another GLP-1 agonist
  • Concurrent use with a DPP4 inhibitor

Policy note: Ozempic is a non-preferred agent on the Apple Health PDL. As a non-preferred brand, it requires step-through of BOTH metformin AND liraglutide (the preferred agents) for the standard T2DM indication. The A1C min of 6.5 reflects the diagnostic threshold; the step-therapy failure threshold is HbA1c remaining ≥ 7% despite preferred agents. A1C must have been measured within the last 12 months.

Policy effective June 1, 2026 · verified June 4, 2026 · source: Antidiabetics GLP-1 Agonists

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

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Ozempic for T2DM with established CVD — BMI > 30 kg/m²

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 18 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • BMI > 30 kg/m²
  • Established cardiovascular disease (prior stroke, prior MI, symptomatic carotid artery disease, symptomatic CAD, or symptomatic PAD as defined in policy)

Ozempic for T2DM with established CVD — BMI 27–30 kg/m² with liraglutide step-through

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 18 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • BMI 27–30 kg/m²
  • Established cardiovascular disease (prior stroke, prior MI, symptomatic carotid artery disease, symptomatic CAD, or symptomatic PAD as defined in policy)
  • History of failure on liraglutide at maximum tolerated dose for a minimum of 90 continuous days (inability to achieve HbA1c < 7%), unless not tolerated, contraindicated, or clinically inappropriate

Documentation to bring

  • Diagnosis of type 2 diabetes OR HbA1c lab result ≥ 6.5 within the last 12 months
  • Documentation of patient age (≥ 18 years)
  • Documentation confirming drug will not be combined with another GLP-1 agonist or DPP4 inhibitor
  • Current BMI measurement (must be > 30 kg/m² for no prior GLP-1 required; 27–30 kg/m² requires liraglutide step-through)
  • Documentation of qualifying established cardiovascular disease event — one of: prior stroke; prior MI; symptomatic carotid artery disease (stenosis >50%, internal carotid revascularization, or TIA with focal neurological symptoms); symptomatic CAD (coronary stenosis ≥50%, symptomatic angina pectoris, or prior coronary revascularization); symptomatic PAD (claudication with ABI <0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • If BMI 27–30 kg/m²: Documentation of liraglutide trial at maximum tolerated dose for ≥ 90 continuous days with inadequate response, OR documentation of intolerance/contraindication/clinical inappropriateness

Quantity limits

  • 2mg/3mL pen — 3 mL per 28 days
  • 4mg/3mL pen — 3 mL per 28 days
  • 8mg/3mL pen — 3 mL per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. CV disease documentation and BMI requirements are NOT re-verified at continuation.

Not covered when

  • Concurrent use with another GLP-1 agonist
  • Concurrent use with a DPP4 inhibitor

Policy note: This indication requires T2DM (does NOT exclude diabetes — it is specifically for T2DM patients with established CVD). The policy distinguishes between BMI > 30 (no liraglutide step-through required) and BMI 27–30 (liraglutide step-through required). Specific CVD qualifying conditions are detailed in the policy including carotid artery disease, CAD, and PAD with objective criteria. No GDMT requirement beyond the CVD diagnosis documentation itself.

Policy effective June 1, 2026 · verified June 4, 2026 · source: Antidiabetics GLP-1 Agonists

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Full requirements: Ozempic for Kidney Disease (CKD) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Ozempic for CKD in T2DM — eGFR 50–75 with high albuminuria

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 18 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • Diagnosis of chronic kidney disease
  • eGFR 50–75 mL/min with UACR > 300 mg/g within the last 12 months
  • Patient is taking an ACE inhibitor or ARB at maximum tolerated dose, unless contraindicated or not tolerated

Ozempic for CKD in T2DM — eGFR 25 to <50 with moderate albuminuria

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 18 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • Diagnosis of chronic kidney disease
  • eGFR 25 to <50 mL/min with UACR > 100 mg/g within the last 12 months
  • Patient is taking an ACE inhibitor or ARB at maximum tolerated dose, unless contraindicated or not tolerated

Documentation to bring

  • Diagnosis of type 2 diabetes OR HbA1c lab result ≥ 6.5 within the last 12 months
  • Documentation of patient age (≥ 18 years)
  • Documentation confirming drug will not be combined with another GLP-1 agonist or DPP4 inhibitor
  • Diagnosis of chronic kidney disease
  • eGFR lab result within the last 12 months (must be 50–75 mL/min with UACR >300 mg/g, OR 25 to <50 mL/min with UACR >100 mg/g)
  • UACR lab result within the last 12 months
  • Documentation that patient is taking an ACE inhibitor or ARB at maximum tolerated dose, OR documentation of contraindication or intolerance

Quantity limits

  • 2mg/3mL pen — 3 mL per 28 days
  • 4mg/3mL pen — 3 mL per 28 days
  • 8mg/3mL pen — 3 mL per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. eGFR/UACR lab values and ACE inhibitor/ARB requirement are NOT re-verified at continuation.

Not covered when

  • Concurrent use with another GLP-1 agonist
  • Concurrent use with a DPP4 inhibitor

Policy note: Two eGFR/UACR pathways exist: (1) eGFR 50–75 mL/min requires UACR >300 mg/g; (2) eGFR 25 to <50 mL/min requires UACR >100 mg/g. Both lab values must be within the last 12 months. GDMT here is specifically ACE inhibitor or ARB (not a broad GDMT bundle). egfr min set to 25 (lower bound of lower pathway); egfr max left null as the upper pathway goes to 75 — two distinct ranges captured in qualification pathways. uacr min set to 100 (the lower threshold applicable to the lower eGFR pathway).

Policy effective June 1, 2026 · verified June 4, 2026 · source: Antidiabetics GLP-1 Agonists

Open on its own page →

Questions people ask
Does Washington Medicaid cover Ozempic?
Yes. Washington Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Washington Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months. Kidney Disease (CKD) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Washington Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. BMI and prior therapy step requirements are NOT re-verified at continuation. Heart Disease Risk Reduction — Applies to Medicaid plans. Improvement in A1C. HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. CV disease documentation and BMI requirements are NOT re-verified at continuation. Kidney Disease (CKD) — Applies to Medicaid plans. Improvement in A1C. HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. eGFR/UACR lab values and ACE inhibitor/ARB requirement are NOT re-verified at continuation.
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 Washington

These names map to Washington Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Washington Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Kaiser Permanente Northwest, Molina Healthcare, Premera, Regence, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health

All insurance plans · All medications

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