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West Virginia Medicaid

Does West Virginia Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. West Virginia Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. 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 with requirements. See the qualification pathways below.

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

Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — Initial Approval

All of:

  • Patient is within the FDA-label recommended age range
  • BMI ≥ 27 kg/m2 (date and results of most recent BMI calculation stated on request)
  • Prescribed by or in consultation with an M.D./D.O. or specialty trained prescriber with clinical specialty certification/degree in cardiology, vascular surgery, or neurology
  • Patient attests to behavioral modification including a reduced calorie diet and increased physical activity
  • HbA1c level taken within the last 6 months is provided
  • HbA1c ≤ 6.5%
  • Patient does NOT have type 1 or type 2 diabetes
  • Medication will not be used with other GLP-1 agonist agents

Plus any one of:

  • Prior myocardial infarction
  • Prior stroke
  • Symptomatic peripheral arterial disease (PAD) demonstrated by: formal vascular laboratory testing showing intermittent claudication with ABI ≤ 0.85 at rest, OR peripheral revascularization procedure, OR amputation due to atherosclerotic disease

Documentation to bring

  • Documentation of BMI ≥ 27 kg/m2 with date and results of most recent BMI calculation
  • Prescription by or documentation of consultation with M.D./D.O. or specialist in cardiology, vascular surgery, or neurology
  • Documentation of qualifying CV event: prior MI, prior stroke, or symptomatic PAD (with supporting vascular lab results showing ABI ≤ 0.85, or evidence of peripheral revascularization or amputation due to atherosclerotic disease)
  • Patient attestation of behavioral modification including reduced calorie diet and increased physical activity
  • HbA1c lab result taken within the last 6 months
  • Confirmation that patient does not have type 1 or type 2 diabetes and HbA1c is ≤ 6.5%
  • Confirmation that medication will not be co-administered with other GLP-1 agonist agents

Approval and renewal

  • Initial approval: 3 months
  • Renewal: every 6 months
  • Renewal: Patient continues to meet all initial approval criteria AND demonstrates continued documented compliance AND is taking an appropriate maintenance dose of 1.7 mg or 2.4 mg per week. If 1.7 mg dose is intolerable, medication should be discontinued. Initial approval criteria (including T2DM/T1DM exclusion and A1C ≤ 6.5%) are re-verified at continuation.
  • Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

  • Type 2 diabetes (excluded — HbA1c must be ≤ 6.5% and no T1DM or T2DM diagnosis)
  • Concomitant use with other GLP-1 agonist agents
  • Type 1 diabetes

Policy note: HbA1c > 6.5% is an exclusion criterion. Both type 1 and type 2 diabetes are explicitly excluded. Symptomatic PAD must be demonstrated by one of three specified methods: ABI ≤ 0.85 on formal vascular lab testing, peripheral revascularization procedure, or amputation due to atherosclerotic disease. Initial approval is 90 days; continuation approvals are 6 months. Prescriber must be an M.D./D.O. or specialty-certified in cardiology, vascular surgery, or neurology.

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 Wegovy?
Yes. West Virginia Medicaid covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with West Virginia Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 3 months. Renewal: every 6 months.
What does West Virginia Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Patient continues to meet all initial approval criteria AND demonstrates continued documented compliance AND is taking an appropriate maintenance dose of 1.7 mg or 2.4 mg per week. If 1.7 mg dose is intolerable, medication should be discontinued. Initial approval criteria (including T2DM/T1DM exclusion and A1C ≤ 6.5%) are re-verified at continuation. Staying on a maintenance dose of at least 1.7 mg.
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, Ozempic, Zepbound

Wegovy under other plans: Highmark, Alabama 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.