Does Medicaid Cover Victoza? Criteria, Copay, How to Appeal
Yes for type 2 diabetes: every state Medicaid program covers GLP-1 diabetes drugs like Victoza, usually with prior authorization. Only 10 states also cover GLP-1s for weight loss.
- States covering weight loss
- 10
- Covered for type 2 diabetes
- Every state
- States covering in January 2026
- 13
- Prior authorization
- Typical
Victoza in brief
Its half-life is about 13 hours: after 13 h, half is gone, and five half-lives (2.7 d) leave about 3%.
People with type 2 diabetes in the 52-week LEAD-3 trial lost 2.5 kg, compared with 1.1 kg for those on placebo.
Sources: FDA label (DailyMed).
Does Medicaid cover Victoza?
| Medicine | Approved for | Medicaid covers it in |
|---|---|---|
| Victoza | Type 2 diabetes and heart risk | Every state |
Sources: Novo Nordisk pricing, KFF.
The published policy
- Whether states must cover diabetes GLP-1s: Yes
- As of October 2025, 16 states cover weight loss
- Weight loss coverage, January 2026: 13 states
- You must get prior authorization
- Changes in 2026:
- Michigan: Covered under tighter rules in place since January 2026; the change takes effect January 1, 2026, see details
- Pennsylvania: Coverage ended as of January 2026; the change takes effect January 1, 2026, see
- Utah: Its pilot ended in June 2026; the change takes effect June 30, 2026, see
- Wisconsin: Covered, and you need prior authorization (effective July 1, 2026)
- Massachusetts: Its coverage ended in July 2026; the change takes effect July 3, 2026, see
- Rhode Island: Its coverage ended in October 2026; the change takes effect October 1, 2026, see
Read the policy itself: KFF.
Sources: KFF, michigan.gov, pa.gov, medicaid-documents.dhhs.utah.gov.
Prior authorization checklist
- Diagnosis: Your chart lists an approved use of Victoza, either for type 2 diabetes or for heart risk.
- You must get prior authorization
- Records: Your recent A1C results, and the diabetes drugs you have tried before.
- Who files it: Your prescriber sends the request, not you.
Source: KFF.
If you are denied: how to appeal
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends the plan's form with your type 2 diabetes diagnosis and recent A1C. |
| The plan wants another drug first | Ask which drugs the plan wants tried first, and provide records of the drugs you already tried |
| The drug is not on the plan's list | Ask which GLP-1 the plan would rather you use, and request a formulary exception. |
- Get the denial notice from your Medicaid plan.
- Your prescriber can file the prior authorization again, with chart notes attached.
- If the plan still says no, you may request a state fair hearing.
What changes by state and plan
| State | For weight loss | For type 2 diabetes | Prior authorization |
|---|---|---|---|
| Alabama | Not covered | Covered | Not listed |
| Alaska | Not covered | Covered | Not listed |
| Arizona | Not covered | Covered | Not listed |
| Arkansas | Not covered | Covered | Not listed |
| California | Ended January 2026 | Covered | Not listed |
| Colorado | Not covered | Covered | Not listed |
| Connecticut | Not covered | Covered | Not listed |
| Delaware | Covered with prior authorization | Covered | Required |
| District of Columbia | Not covered | Covered | Not listed |
| Florida | Not covered | Covered | Not listed |
| Georgia | Not covered | Covered | Not listed |
| Hawaii | Not covered | Covered | Not listed |
| Idaho | Not covered | Covered | Not listed |
| Illinois | Not covered | Covered | Not listed |
| Indiana | Joining BALANCE, start date not set | Covered | Not listed |
| Iowa | Not covered | Covered | Not listed |
| Kansas | Covered with prior authorization | Covered | Required |
| Kentucky | Not covered | Covered | Not listed |
| Louisiana | Not covered, law allows coverage from 2027 | Covered | Not listed |
| Maine | Not covered | Covered | Not listed |
| Maryland | Not covered | Covered | Not listed |
| Massachusetts | Ended July 2026 | Covered | Required |
| Michigan | Covered, tighter rules since January 2026 | Covered | Required |
| Minnesota | Covered with prior authorization | Covered | Required |
| Mississippi | Covered | Covered | Not listed |
| Missouri | Covered with prior authorization | Covered | Required |
| Montana | Not covered | Covered | Not listed |
| Nebraska | Not covered | Covered | Not listed |
| Nevada | Not covered | Covered | Not listed |
| New Hampshire | Ended January 2026 | Covered | Not listed |
| New Jersey | Not covered | Covered | Not listed |
| New Mexico | Not covered | Covered | Not listed |
| New York | Not covered | Covered | Not listed |
| North Carolina | Covered with prior authorization | Covered | Required |
| North Dakota | Not covered | Covered | Not listed |
| Ohio | Not covered | Covered | Not listed |
| Oklahoma | Not covered | Covered | Not listed |
| Oregon | Not covered | Covered | Not listed |
| Pennsylvania | Ended January 2026 | Covered | Not listed |
| Rhode Island | Ended October 2026 | Covered | Required |
| South Carolina | Ended January 2026 | Covered | Not listed |
| South Dakota | Not covered | Covered | Not listed |
| Tennessee | Covered with prior authorization | Covered | Required |
| Texas | Not covered | Covered | Not listed |
| Utah | Pilot ended June 2026 | Covered | Required |
| Vermont | Not covered | Covered | Not listed |
| Virginia | Covered with strict service authorization | Covered | Required |
| Washington | Not covered | Covered | Not listed |
| West Virginia | Not covered | Covered | Not listed |
| Wisconsin | Covered with prior authorization | Covered | Required |
| Wyoming | Not covered | Covered | Not listed |
Sources: KFF, medicaidpublications.dhss.delaware.gov, events.in.gov, kdhe.ks.gov.