Does Molina cover Wegovy for weight loss?
Molina Healthcare provides coverage for Ozempic (semaglutide) when it is prescribed as an adjunct to diet and exercise for adult patients diagnosed with type 2 diabetes mellitus. To secure coverage approval, prescribing physicians must submit a prior authorization request documenting the type 2 diabetes diagnosis, baseline hemoglobin A1c levels, and records demonstrating an inadequate response, intolerance, or contraindication to traditional first-line oral antidiabetic therapies such as metformin. Because Ozempic is FDA-approved specifically for type 2 diabetes management, Molina generally does not cover the medication if it is prescribed solely for off-label cosmetic weight loss.
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Molina Healthcare coverage for Wegovy (semaglutide) for chronic weight management or weight loss depends significantly on the specific state plan, line of business (such as Managed Medicaid, Medicare, or Marketplace), and local benefit exclusions.
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