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Wisconsin Medicaid

Does Wisconsin Medicaid cover Wegovy for Liver Disease (MASH)?

Yes. Wisconsin Medicaid covers Wegovy for liver disease (MASH) with prior authorization. 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 Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH — Noncirrhotic MASH with moderate to advanced fibrosis

All of:

  • Wegovy prescribed consistent with FDA-approved labeling
  • Diagnosis of noncirrhotic MASH (formerly NASH) with moderate to advanced liver fibrosis consistent with stages F2 to F3
  • Fibrosis confirmed by biopsy or noninvasive tests (FibroScan MRE + MRI-PDFF)
  • Member will use medication in conjunction with diet and exercise
  • Prescriber documents no significant alcohol consumption within the past year
  • Prescription written by a liver specialist physician (gastroenterologist or hepatologist)
  • Prescriber will monitor for elevations in liver tests and development of liver-related adverse reactions

Documentation to bring

  • Completed, signed, and dated PA/DGA form Section VI
  • Completed PA/RF
  • Supporting clinical information and copy of member's current medical records
  • Documentation of member's medical condition (noncirrhotic MASH with F2-F3 fibrosis)
  • Biopsy results or noninvasive test results (FibroScan MRE + MRI-PDFF) confirming F2-F3 fibrosis
  • Documentation of no significant alcohol consumption within the past year
  • Documentation of prescriber identity as liver specialist (gastroenterologist or hepatologist)
  • Details regarding previous medication use
  • Member's current treatment plan

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Initial renewal (up to 183 days): documentation that member is responding adequately to treatment as documented in laboratory tests; appropriate maintenance dose per Wegovy PI; adherence required. Subsequent renewals (up to 365 days): documentation of adequate treatment response via laboratory tests AND biopsy or noninvasive tests (FibroScan or MRE + MRI-PDFF) showing either resolution of steatohepatitis without worsening of fibrosis OR at least one stage improvement in fibrosis without worsening of steatohepatitis; appropriate maintenance dose; adherence required.

Not covered when

  • Cirrhotic MASH is excluded — only noncirrhotic MASH qualifies
  • Significant alcohol consumption within the past year is a disqualifier
  • Must be adherent with prescribed treatment regimen for renewal
  • Subsequent renewal requires documented histologic or imaging response
  • Cannot be submitted via DAPO Center or STAT-PA system — portal, fax, or mail only

Policy note: ForwardHealth (Wisconsin Medicaid). Separate PA pathway and submission form (PA/DGA Section VI) from general anti-obesity criteria. Requires prescription by a gastroenterologist or hepatologist. Noninvasive test confirmation described as 'FibroScan MRE (magnetic resonance enterography) + MRI-PDFF (proton density fat fraction)' — this appears to refer to FibroScan and/or MRE with MRI-PDFF. Subsequent renewals require objective evidence of treatment response (histologic or imaging). No BMI threshold is stated for the MASH indication specifically. Fibrosis staging F2-F3 (noncirrhotic).

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 liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Wisconsin Medicaid?
Liver Disease (MASH) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Wisconsin Medicaid require to renew Wegovy?
Liver Disease (MASH) — Applies to Medicaid plans. Initial renewal (up to 183 days): documentation that member is responding adequately to treatment as documented in laboratory tests; appropriate maintenance dose per Wegovy PI; adherence required. Subsequent renewals (up to 365 days): documentation of adequate treatment response via laboratory tests AND biopsy or noninvasive tests (FibroScan or MRE + MRI-PDFF) showing either resolution of steatohepatitis without worsening of fibrosis OR at least one stage improvement in fibrosis without worsening of steatohepatitis; appropriate maintenance dose; adherence required.
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.