Medicaid Pharmacy Coverage of Wegovy® for Cardiovascular Indications Only
Date: 07/01/24
Effective July 1, 2024, the Louisiana Medicaid Preferred Drug List (PDL) will implement clinical criteria for coverage of Wegovy® (semaglutide) for Medicaid members with established cardiovascular disease.
Wegovy was initially approved by the FDA in 2021 to treat obesity, demonstrating its substantial efficacy in promoting weight loss. However, recent studies have revealed its impact in mitigating cardiovascular risks.
In March of 2024, the FDA approved an expanded indication for Wegovy to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight in addition to a reduced calorie diet and increased physical activity1. This new expanded indication has prompted its coverage by Louisiana Medicaid for cardiovascular risk reduction.
Coverage of Wegovy allows Louisiana Healthcare Connections providers to prescribe Wegovy for this specific eligible population of members with established cardiovascular disease. Please note that coverage is not all-inclusive, as prescription agents used for weight loss still remain a Louisiana Medicaid benefit exclusion.
Wegovy coverage by Louisiana Healthcare Connections Medicaid will be approved after clinical authorization review for patients who meet the clinical criteria listed on the LDH PDL and who have a completed Wegovy Patient Agreement as listed on the LDH PDL.
To initiate a PA for Wegovy, providers should submit a Prior Authorization on the Uniform PA Form with a completed Wegovy Patient Agreement Form to Magellan Medicaid Administration (MMA)
- To Submit by Phone: 1-800-424-1664
- To Submit by Fax: 1-800-424-7402
- To Submit Online: www.CoverMyMeds.com
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