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Wisconsin Medicaid

Does Wisconsin Medicaid cover Wegovy for Heart Disease Risk Reduction?

Yes. Wisconsin 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

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan · Medicaid card names in Wisconsin

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 — Established CVD with overweight/obesity

All of:

  • Wegovy prescribed consistent with FDA-approved labeling
  • BMI ≥ 27
  • Member agrees to follow reduced-calorie diet and increase physical activity

Plus any one of:

  • Prior myocardial infarction (heart attack)
  • Prior stroke
  • Peripheral arterial disease evidenced by intermittent claudication with ABI ≤ 0.9
  • Peripheral arterial disease evidenced by peripheral arterial revascularization procedure due to atherosclerotic disease
  • Peripheral arterial disease evidenced by amputation due to atherosclerotic disease

Documentation to bring

  • Completed, signed, and dated PA/DGA form (F-11049) Section V
  • Completed PA/RF
  • Supporting clinical information and copy of member's current medical records
  • Evidence that member has established cardiovascular disease (prior MI, prior stroke, or PAD documentation)
  • Member's current BMI documentation (≥ 27 kg/m²)
  • Member's current treatment plan including reduced-calorie diet and physical activity plan

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Initial renewal (up to 183 days): documentation that member continues to follow reduced-calorie diet and maintains physical activity; member must be on appropriate maintenance dose per Wegovy PI; member must be adherent with prescribed treatment regimen. Subsequent renewals (up to 365 days): same diet/activity documentation; appropriate maintenance dose; adherence required. No weight loss threshold specified for renewal.

Not covered when

  • Must be adherent with prescribed treatment regimen for renewal
  • Renewal requires member to be on appropriate maintenance dose per Wegovy prescribing information
  • Cannot be submitted via DAPO Center or STAT-PA system — portal, fax, or mail only

Policy note: ForwardHealth (Wisconsin Medicaid). This is a separate PA pathway from the general anti-obesity weight loss indication with different submission requirements (PA/DGA form Section V rather than the Anti-Obesity Drug Attachment F-00163). No weight loss threshold is required for renewal under this indication. Subsequent renewals approved for up to 365 days (vs. 183 days for initial/first renewal). The document does not specify that diabetes must be excluded — the indication is available to overweight/obese adults with established CVD regardless of diabetes status.

verified June 3, 2026 · source: Wisconsin Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Wisconsin Medicaid cover Wegovy?
Yes. Wisconsin 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 Wisconsin Medicaid?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Wisconsin Medicaid require to renew Wegovy?
Heart Disease Risk Reduction — Applies to Medicaid plans. Initial renewal (up to 183 days): documentation that member continues to follow reduced-calorie diet and maintains physical activity; member must be on appropriate maintenance dose per Wegovy PI; member must be adherent with prescribed treatment regimen. Subsequent renewals (up to 365 days): same diet/activity documentation; appropriate maintenance dose; adherence required. No weight loss threshold specified for renewal.
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.

Card and program names on file in Wisconsin

These names map to Wisconsin Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Wisconsin Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Alabama Medicaid, California Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, EmblemHealth

All insurance plans · All medications

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