HUSKY Health does cover Wegovy, but only for two specific medical conditions: reducing the risk of heart attack, stroke, or cardiovascular death in adults with established heart disease, and treating an advanced form of fatty liver disease called metabolic-associated steatohepatitis (MASH). Wegovy prescribed for weight loss alone is not covered under Connecticut’s Medicaid program.
The Two Conditions HUSKY Will Cover Wegovy For
Coverage began February 3, 2025, for the cardiovascular indication and expanded November 3, 2025, to include MASH.1Scribd. GLP-1 DSS Bulletin 2025-04 Wegovy2CT DSS Map. Provider Bulletin 2025-54: Wegovy Coverage for MASH and MACE The clinical bar is high for both.
For cardiovascular risk reduction, a patient must be 18 or older with a documented history of heart attack, stroke, or symptomatic peripheral arterial disease. Hemoglobin A1c must be 6.5% or higher, BMI must be below 27, and the patient must be participating in a lifestyle program covering diet, exercise, and behavioral therapy. To renew coverage after the first year, the patient has to show at least 5% weight loss from their starting weight.3CT DSS Map. Wegovy for MACE Risk Reduction Prior Authorization Form
For MASH, the criteria are stricter. A patient needs biopsy-confirmed steatohepatitis with stage F2 or F3 liver fibrosis, a NAFLD Activity Score of at least 4, no hepatic decompensation (or a MELD score of 12 or lower), and liver enzymes no more than five times the normal range. Other causes of chronic liver disease must be ruled out, alcohol use must be limited, A1c must be below 9.5%, and the patient must be enrolled in lifestyle interventions.4CT DSS Map. Wegovy for MASH Prior Authorization Form
What HUSKY Will Not Cover Wegovy For
Weight management by itself is excluded. This is consistent with the broader HUSKY pharmacy benefit, which generally does not cover drugs prescribed to treat obesity.5Connecticut Department of Social Services. HUSKY Health Pharmacy The exclusion applies even though the FDA has approved Wegovy for chronic weight management in adults with obesity or overweight.6U.S. Food and Drug Administration. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults With Obesity or Overweight
Two other groups are also outside coverage. Wegovy is not covered for patients with Type 1 or Type 2 diabetes, and in the cardiovascular context it is not covered for patients with the most severe form of heart failure.2CT DSS Map. Provider Bulletin 2025-54: Wegovy Coverage for MASH and MACE Patients with diabetes seeking a GLP-1 through HUSKY would need to look at drugs approved for that indication, such as Ozempic, Trulicity, or Victoza.7Connecticut General Assembly. DSS Presentation, December 2025
Which HUSKY Programs Include Wegovy
The November 2025 bulletin lists Wegovy coverage under HUSKY A, C, and D.2CT DSS Map. Provider Bulletin 2025-54: Wegovy Coverage for MASH and MACE The earlier February 2025 bulletin covering the cardiovascular indication also included HUSKY B.1Scribd. GLP-1 DSS Bulletin 2025-04 Wegovy What those categories cover:
- HUSKY A: Medicaid for children, their parents or caregivers, and pregnant individuals.
- HUSKY B: The Children’s Health Insurance Program for uninsured children in higher-income households.
- HUSKY C: Medicaid for residents aged 65 and older and people with disabilities.
- HUSKY D: Medicaid for low-income adults aged 19 to 64 without dependent children.8Access Health CT. Eligibility for Medicaid, HUSKY Health, CHIP
Members in programs A, C, and D have no out-of-pocket costs for covered prescriptions.5Connecticut Department of Social Services. HUSKY Health Pharmacy
Prior Authorization: What Your Provider Has to Do
Every Wegovy prescription requires prior authorization, and the paperwork is indication-specific. Providers submit one form for the cardiovascular indication and a different one for MASH, both at the start of therapy and then annually to continue coverage.2CT DSS Map. Provider Bulletin 2025-54: Wegovy Coverage for MASH and MACE Each prescription must carry a diagnosis code tied to the approved indication. Without that code, the claim is denied.
If a patient doesn’t meet the standard criteria on the form, the provider can submit a Letter of Medical Necessity for individual review. Approval isn’t guaranteed.
If You Are Denied Coverage
A denial is not the end of the process. Ask your provider whether a Letter of Medical Necessity has been submitted; it is the standard route for cases that fall outside the checklist on the prior authorization form.
If the denial holds, you have the right to a fair hearing through the Department of Social Services. The request must be filed within 60 days of the date on the denial notice. You can use the hearing request form attached to the notice, or send a signed letter to the DSS hearing office that includes your name, address, HUSKY identification number, and the decision you are appealing.9Connecticut Department of Social Services. Requesting a Hearing If you file before the denial’s effective date, benefits may continue while the appeal is pending.
For help understanding a denial or figuring out what documentation is missing, the Pharmacy Client Assistance Center can be reached at 1-866-409-8430.5Connecticut Department of Social Services. HUSKY Health Pharmacy
Why Weight-Loss Coverage Is Still Off the Table
The exclusion has been contested. In 2023, the Connecticut legislature passed Public Act 23-94, which required the Department of Social Services to provide Medicaid coverage for FDA-approved prescription drugs to treat obesity, along with bariatric surgery and nutritional counseling.10CT Mirror. CT GLP-1 Weight Loss Drug Coverage Legislators and advocates read that to include GLP-1s such as Wegovy. The Lamont administration read it differently, saying the statute mandated weight-loss services in general but no specific drug class.
Cost has driven the disagreement. In fiscal year 2024, GLP-1 drugs cost Connecticut’s Medicaid program $85 million after rebates, or 35% of the entire annual pharmaceutical budget, and prescriptions had risen more than 500% between 2019 and 2023.10CT Mirror. CT GLP-1 Weight Loss Drug Coverage In early 2025, DSS told physicians it would stop paying for GLP-1s prescribed solely for weight loss, with a final cutoff of July 31, 2025.11CT DSS Map. Provider Bulletin 2025-31 The state sought federal approval to cover two older weight-loss drugs, orlistat and phentermine, and began covering dietitian-nutritionist services in their place.12Connecticut Department of Social Services. SPA 25-0014: New Coverage for Obesity Medications
Governor Lamont’s budget proposal, Senate Bill 1251, would formally repeal the 2023 mandate, with projected savings of about $45.6 million over two fiscal years.13CT Governor’s Office. SB 1251 Fact Sheet Sheldon Toubman of Disability Rights Connecticut called the state’s refusal to cover GLP-1s “a blatant violation” of the 2023 law.10CT Mirror. CT GLP-1 Weight Loss Drug Coverage Countering the governor, Senate Bill 1474 would rewrite the definition of “weight loss drugs” to explicitly include FDA-approved GLP-1s and would require coverage for patients with a BMI of 35 or higher.14Connecticut General Assembly. Raised Bill No. 1474 As of the most recent available information, SB 1474 had been referred to the Committee on Human Services but had not advanced.
Until that fight resolves, the answer for HUSKY members remains the same: Wegovy is covered for cardiovascular risk reduction and MASH, and not for weight loss on its own.