MedicaidPrior AuthMedium impact
2025.54 - Wegovy Coverage for MASH & MACE
Connecticut Medicaid (HUSKY Health)·CT · Gastroenterology, Endocrinology, Internal Medicine +1 more·Provider Bulletin
Effective date
Nov 3, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid will now cover Wegovy for Metabolic-Associated Steatohepatitis (MASH) in adults 18+ starting November 3, 2025. All Wegovy prescriptions will require both prior authorization and specific diagnosis codes, with separate PA forms for MASH vs. cardiovascular indications.
Action Required
By November 3, 2025: Billing team must obtain new 'Wegovy for MASH Prior Authorization Form' from www.ctdssmap.com and update billing system to require diagnosis codes for all Wegovy prescriptions. Providers must complete PA requests for MASH patients meeting criteria (histologically documented steatohepatitis, NAS ≥4, MELD ≤12, AST/ALT ≤5x upper limit). Download payable diagnosis code list from website. Claims without proper PA and diagnosis codes will be denied.