MedicaidCoverageMedium impact
Coverage of Wegovy for Overweight or Obese Adults with Cardiovascular Disease, Effective September 15, 2024
Maryland Medicaid·MD · Cardiology, Endocrinology, Family Medicine +1 more·Hospital
Effective date
Sep 15, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid will now cover Wegovy for adults 18+ who are overweight/obese with established cardiovascular disease, but NOT for diabetes patients or weight management alone. Prior authorization required with specific medical documentation.
Action Required
By September 15, 2024: Billing team must update prior authorization procedures for Wegovy claims using HCPCS J3490. Verify patients meet all criteria: 18+ years old, documented cardiovascular disease, overweight/obese, NO diabetes, and have supporting medical documentation. Update billing system to price per invoice with billable units as 1 ml. Claims for weight management alone will be denied.