Agencies
Services
Provider Notice issued 09/10/2026
To reduce the risk of major adverse cardiovascular events (MACE) (cardiovascular (CV) death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight.
For the treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) in adults.
To reduce the risk of major adverse CV events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight.
To treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.
Coverage of Wegovy for MACE and MASH, and Zepbound for OSA
| To: |
Enrolled Pharmacies, Physicians, and Advanced Practice Registered Nurses |
| Re: |
Coverage of Wegovy for MACE and MASH, and Zepbound for OSA |
| Date: |
September 10, 2026 |
The purpose of this notice is to inform Medicaid providers of updated coverage policies for Wegovy (semaglutide tablets and injection) and Zepbound (tirzepatide). These changes apply to both the Fee-For-Service (FFS) program and Managed Care program.
Effective October 1, 2026, the Department will provide coverage for Wegovy and Zepbound when prescribed for the FDA approved indications in adults below:
Wegovy (injection):
Wegovy (tablets):
Zepbound (injection):
Both medications will require prior authorization. Providers should submit:
• A completed prior authorization request
• Diagnostic documentation confirming the qualifying condition
• Recent clinical notes demonstrating medical necessity
• Any additional information requested by the Department or the MCO, as applicable.
At this time Wegovy and Zepbound will not be covered for weight loss alone.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.
Laura Phelan, Administrator
Division of Medical Programs