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Washington Medicaid

Does Washington Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. Washington Medicaid covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • 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: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initial approval: Moderate to severe noncirrhotic MASH (F2-F3) without diabetes

All of:

  • Age ≥ 18 years
  • No diabetes and A1C ≤ 6.5% (patients with T2DM or A1C >6.5 referred to GLP-1 diabetes policy 27.17.00)
  • Diagnosis of moderate to severe MASH (fibrosis stage F2 or F3) confirmed by at least one listed method
  • At least one cardiovascular risk factor from Appendix A (CKD, dyslipidemia, hypertension, obesity BMI ≥30, or prediabetes)

Plus any one of:

  • Liver biopsy confirming F2-F3 fibrosis
  • FIB-4 score 1.3 to 3.48
  • FibroScan score 8.5 to 13.5 kPa
  • APRI score 1.0 to 1.9
  • Fibrotest score 0.49 to 0.74
  • Elastography (ARFI/PSWE) 1.38 to 2.33 m/s

Reauthorization: MASH

All of:

  • Member has received previous authorization approval OR has been established on therapy from another health plan (excludes samples, patient assistance programs, or coupons)
  • Patient continues to meet initial criteria 1-4 (age, no T2DM/A1C >6.5%, MASH F2-F3 confirmation, CV risk factor)
  • Patient does not have cirrhosis (fibrosis score must not be >F3)

Documentation to bring

  • Documentation confirming no diabetes diagnosis and A1C ≤ 6.5%
  • Diagnosis of moderate to severe noncirrhotic MASH (F2 or F3) confirmed by one of: liver biopsy, FIB-4 score 1.3-3.48, FibroScan 8.5-13.5 kPa, APRI 1.0-1.9, Fibrotest 0.49-0.74, or Elastography (ARFI/PSWE) 1.38-2.33 m/s
  • Documentation of at least one cardiovascular risk factor (CKD, dyslipidemia, hypertension, obesity BMI ≥30, or prediabetes)

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL, 1.7 mg/0.75 mL — 4 pens per 28 days (1 box of 4 pens) — Initial PA
  • 2.4 mg/0.75 mL — 4 pens per 28 days (1 box of 4 pens) — Renewal PA

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Patient must continue to meet initial criteria 1-4 (age ≥18, no T2DM/A1C >6.5%, MASH F2-F3 diagnosis confirmed, at least one cardiovascular risk factor) AND patient must not have cirrhosis (fibrosis score must not be >F3). Noncirrhotic status re-verified at reauthorization.

Not covered when

  • Patients with T2DM or A1C > 6.5% are excluded (referred to GLP-1 diabetes policy 27.17.00)
  • Cirrhosis (fibrosis stage >F3) is an exclusion at reauthorization
  • Only injectable formulation (not tablet) covered for MASH indication

Policy note: MASH indication covers only Wegovy injection, not the Wegovy tablet. The policy title spells 'nonalchoholic' (sic). Fibrosis staging is limited to noncirrhotic disease (F2-F3); cirrhosis (>F3) is an explicit exclusion at reauthorization. Cardiovascular risk factors from Appendix A are listed as 'including but not limited to': CKD, dyslipidemia, hypertension, obesity (BMI ≥30), and prediabetes. No lookback periods are specified for any confirmation method. Specific score ranges are provided for each non-biopsy confirmation method mapping to F2-F3 disease.

Policy effective February 1, 2026 · verified June 4, 2026 · source: Semaglutide · View policy document (PDF)

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Questions people ask
Does Washington Medicaid cover Wegovy?
Yes. Washington Medicaid covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Washington Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Washington Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. Patient must continue to meet initial criteria 1-4 (age ≥18, no T2DM/A1C >6.5%, MASH F2-F3 diagnosis confirmed, at least one cardiovascular risk factor) AND patient must not have cirrhosis (fibrosis score must not be >F3). Noncirrhotic status re-verified at reauthorization.
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, Ozempic, Zepbound

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

All insurance plans · All medications

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