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Washington Medicaid

Does Washington Medicaid cover Ozempic for Kidney Disease (CKD)?

Yes. Washington Medicaid covers Ozempic for kidney disease (CKD) 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 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

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Questions people ask
Does Washington Medicaid cover Ozempic?
Yes. Washington Medicaid covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Washington Medicaid?
Kidney Disease (CKD) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Washington Medicaid require to renew Ozempic?
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.