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it is a multidisciplinary care team approach that treats weight as one component of a larger hormonal health picture
To participate in the model, state Medicaid programs must sign a State Agreement with CMS and then adopt supplemental rebate agreements (SRAs) with each participating manufacturer that reflects the standard key terms that the participating manufacturers and CMS have agreed to
MAbs 14 , 2095949 (2022)
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
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