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Washington Medicaid

Does Washington Medicaid cover Ozempic for Type 2 Diabetes?

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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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.
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.
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.