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West Virginia Medicaid

Does West Virginia Medicaid cover Ozempic for Type 2 Diabetes?

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

Policy document

  • West Virginia Medicaid Medicaid prior authorization policy

    West Virginia Medicaid · PA policy · Medicaid

    Effective January 1, 2026. Verified June 3, 2026.

    View PDF Download Original insurer source
  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Preferred agent — diagnosis-based authorization

All of:

  • Diagnosis of Diabetes Mellitus Type II

Documentation to bring

  • Documentation of Diabetes Mellitus Type II diagnosis
  • Current A1C lab result (must be ≥ 7%)

Approval and renewal

  • Renewal: Improvement in A1C.
  • Renewal: 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: Ozempic is a PREFERRED agent in the GLP-1 Agonists class. As a preferred agent, PA is authorized with a diagnosis of Diabetes Mellitus Type II (no step therapy through other preferred agents required). The class-level non-preferred criteria (90-day compliance documentation, treatment failure with all preferred agents, A1C ≥ 7%) apply to non-preferred agents; the A1C ≥ 7% requirement and the DPP-4 inhibitor restriction appear to apply class-wide. Re-authorization requires continued compliance documentation and A1C ≤ 8% or continued improvement.

Policy effective January 1, 2026 · verified June 3, 2026 · source: West Virginia Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does West Virginia Medicaid cover Ozempic?
Yes. West Virginia Medicaid covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
What does West Virginia Medicaid require to renew Ozempic?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Re-authorization requires documentation of continued compliance on all diabetic therapies AND A1C must reach goal (A1C ≤ 8% OR demonstrated continued improvement).
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under West Virginia Medicaid: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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