West Virginia Medicaid coverage for Wegovy (Liver

Medicaid

Covered with requirements

What you need to qualify

12 months of a documented diet and exercise program
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH — Initial Approval

All of:

Patient has a diagnosis of noncirrhotic MASH with moderate to advanced liver fibrosis (stage F2 or F3)
Patient is within the FDA-label recommended age range
Prescribed by or in consultation with an M.D./D.O. or specialty trained prescriber with clinical specialty certification/degree in gastroenterology or hepatology
Medication will be used in combination with appropriate diet and exercise therapy; documentation of diet, exercise, and weight loss counseling/treatment provided within the past 12 months must be submitted
Patient is compliant on stable dosages of medications for diabetes, dyslipidemia, and hypertension (where applicable)
For patients with both T2DM and MASH, diabetes therapy must be managed with a GLP-1 receptor agonist approved for that indication at the appropriate dose (per WV Preferred Drug List)
Medication will not be used with other GLP-1 agonist agents

Plus any one of:

Liver biopsy within the past 1 year showing NAFLD activity score >= 4 with score > 1 in ALL of: Steatosis, Ballooning, and Lobular inflammation
Liver stiffness measurement by vibration-controlled transient elastography (e.g., FibroScan) or magnetic resonance elastography (MRE)

Documentation to bring

Diagnosis documentation of noncirrhotic MASH with moderate to advanced liver fibrosis (stage F2 or F3)
Liver biopsy results within the past 1 year showing NAFLD activity score >= 4 with score > 1 in steatosis, ballooning, and lobular inflammation; OR liver stiffness measurement by FibroScan (VCTE) or MRE confirming stage F2 or F3 fibrosis
Prescription by or documentation of consultation with M.D./D.O. or specialist in gastroenterology or hepatology
Documentation of diet, exercise, and weight loss counseling/treatment provided within the past 12 months
Documentation of compliance with stable dosages of medications for diabetes, dyslipidemia, and hypertension (where applicable)
For patients with both T2DM and MASH: documentation that diabetes is managed with a GLP-1 receptor agonist approved for that indication per WV Preferred Drug List
Confirmation that medication will not be co-administered with other GLP-1 agonist agents

Approval and renewal

Initial approval: 3 months
Renewal: every 12 months
To renew, the plan looks for Patient continues to meet all initial approval criteria AND demonstrates continued documented compliance AND has not progressed to stage F4 (cirrhosis) AND demonstrates positive clinical response (resolution of steatohepatitis and no worsening of liver fibrosis, OR at least one stage improvement in liver fibrosis and no worsening of steatohepatitis).

Not covered when

Cirrhosis (stage F4) — patient must have noncirrhotic MASH; progression to F4 results in discontinuation at renewal
Concomitant use with other GLP-1 agonist agents

Policy note: For patients with both T2DM and MASH, Wegovy may be approved for MASH but diabetes management must be handled by a separate GLP-1 agonist approved for that indication (per WV Preferred Drug List). The MASH indication does not exclude diabetic patients. Liver biopsy confirmation requires NAFLD activity score >= 4 with scores > 1 in all three components (steatosis, ballooning, lobular inflammation). Biopsy lookback is 1 year (12 months). No explicit imaging lookback stated for FibroScan/MRE. Continuation at 12 months requires no progression to cirrhosis and documented positive clinical response. Initial approval is 90 days; continuation approvals are 12 months.

Policy effective January 1, 2026 · verified June 3, 2026 · source: download

West Virginia Medicaid coverage for Wegovy (Liver Disease (MASH))