Medicaid
Covered with requirementsWhat you need to qualify
- A1C of 7% or higher
- Prior trial of 3 other GLP-1 medications (Ozempic, Trulicity, and Victoza)
- Lab results confirming eligibility
Qualification pathways
You can qualify through any one of these.
Non-preferred GLP-1 agonist — all criteria must be met
All of:
- Diagnosis of Diabetes Mellitus Type II
- Current A1C submitted and A1C >= 7%
- Documentation of 90 days of compliance on all current diabetic therapies
- Documentation of treatment failure with ALL unique preferred agents in the GLP-1 class (Ozempic, Trulicity, and Victoza)
Documentation to bring
- Documentation of Diabetes Mellitus Type II diagnosis
- Current A1C lab result (must be >= 7%)
- Documentation demonstrating 90 days of compliance on all current diabetic therapies
- Documentation of treatment failure with all preferred GLP-1 agents (Ozempic, Trulicity, Victoza)
Approval and renewal
- Initial approval: 6 months
- Renewal: every 6 months
- To renew, the plan looks for improvement in A1C and Re-authorization requires documentation of continued compliance on all diabetic therapies AND A1C must reach goal (A1C <= 8% OR demonstrated continued improvement).
Not covered when
- GLP-1 agents will NOT be approved in combination with a DPP-4 inhibitor
- Type 1 diabetes
Policy note: Mounjaro (tirzepatide) is listed as a NON-PREFERRED agent in the GLP-1 Agonists class. Approvals are in 6-month intervals. Requires treatment failure with ALL three preferred agents: Ozempic, Trulicity, and Victoza. The class note explicitly prohibits concurrent use with a DPP-4 inhibitor.
Policy effective January 1, 2026 · verified June 3, 2026 · source: download