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Ozempic (same active ingredient, different dosing) is the covered semaglutide product for diabetes Prior authorization required for all GLP-1 agonists Step therapy requirement: must document trial and failure of metformin for at least 90 days BMI requirement: must be 27 or higher with at least one weight-related comorbidity For obesity without diabetes: Wegovy is classified as a weight-loss medication and falls under MassHealth's excluded drug categories No coverage regardless of BMI No coverage even with documented obesity-related conditions like hypertension, sleep apnea, or osteoarthritis This exclusion applies to all MassHealth plans: Standard, CarePlus, CommonHealth, and Family Assistance The policy is codified in the MassHealth Drug List updated quarterly

Maintain your current dose when switching

Our team carefully monitors progress, addresses side effects such as mild nausea or digestive discomfort, and makes adjustments to ensure safety and effectiveness

Kyttaris, Mieler and Pflugfelder report no financial ties to any product mentioned

Your provider will discuss the trade-offs with you so you can choose the right path for your situation