MedicaidCoverageMedium impact
PT 41-26: Updated Clinical Criteria for Wegovy for Adults with Non-cirrhotic Metabolic Dysfunction-associated Steatohepatitis
Maryland Medicaid·MD · Endocrinology, Gastroenterology, Internal Medicine +1 more·Managed Care
Effective date
Dec 18, 2024
We identified it
Jun 18, 2026
Summary
Maryland Medicaid has updated clinical criteria for Wegovy coverage for adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH). This expands previous coverage that was limited to overweight/obese adults with cardiovascular disease.
Action Required
Immediately: Billing team and providers should review the updated clinical criteria for Wegovy prescriptions for Maryland Medicaid patients with MASH. Update prior authorization processes to reflect new coverage criteria. Contact mdh.healthchoiceprovider@maryland.gov for specific questions about the updated criteria.