# Does Nevada Medicaid Cover Wegovy or Zepbound? Heart, MASH and Sleep Apnea Routes By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-06 Canonical page: https://glpwatchdog.org/research/nevada-medicaid-glp1-coverage > Nevada Medicaid will not reimburse weight-management drugs. Its October 2026 manual still approves Wegovy for heart disease or MASH, plus Zepbound for sleep apnea, and since 2026 every Medicaid plan uses one drug list. Criteria, renewals, diabetes drugs and the hearing deadline. ## Key points - Nevada's services manual refuses payment for agents used for weight management. - Wegovy for heart risk needs a BMI of 27 or more, a cardiologist or vascular specialist and no diabetes. - Wegovy for MASH needs stage 2 or 3 fibrosis on biopsy, FibroScan or MRE, with no diabetes bar or specialist rule. - Zepbound for sleep apnea accepts 15 events an hour, or 5 with symptoms, and wants continued CPAP use. - One drug list has applied to every Nevada Medicaid plan since January 2026; hearing requests are due within 90 days. No. As of November 2026, Nevada Medicaid does not pay for Wegovy, Zepbound or any other drug used for weight management; its services manual lists those agents among the drugs it will not reimburse.[1] The same manual approves Wegovy for adults with established heart disease or the liver disease MASH, and Zepbound for adults with sleep apnea and obesity, each with prior authorization.[1] > **About this article.** This page reads Chapter 1200 of the Nevada Medicaid Services Manual, effective November 2, 2026, the state pharmacy manual, the drug list effective November 1, 2026, the state’s single drug list notices and its hearings chapter, as they stood on November 6, 2026. For a side-by-side with other states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker). ## Does Nevada Medicaid cover GLP-1s for weight management? No. Section 1203 of the manual names “agents used for weight management” first on its list of drugs Nevada Medicaid will not reimburse, ahead of fertility and cosmetic drugs.[1] The pharmacy manual from Prime Therapeutics, the state’s pharmacy contractor, repeats the exclusion.[2] The diabetes GLP-1 criteria close the side door too: a GLP-1 written for weight loss is refused unless the patient also has type 2 diabetes.[1] States may exclude weight-loss drugs under federal Medicaid law.[9] Nevada excludes the purpose, not the product, so Wegovy and Zepbound can still be paid for when the prescription is for a different approved use. Our explainer on [why Medicaid covers Ozempic but rarely Wegovy](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) sets out the federal side. ## Do Nevada Medicaid managed care plans use the same rules? Yes, for the drugs on the state list. Since January 1, 2026, Nevada has used a single preferred drug list, and the state says every Medicaid plan follows it.[3] One plan, SilverSummit Healthplan, told members the change also brought in the state’s full Chapter 1200 criteria, including prior authorization and step rules, for the classes on that list.[4] A six-month grace period for medicines that became non-preferred ended on June 30, 2026.[3] So a member in a managed care plan and a fee-for-service member should meet the same tests described here. ## Which GLP-1 uses does Nevada Medicaid cover? *Nevada Medicaid GLP-1 routes, from Medicaid Services Manual Chapter 1200 effective November 2, 2026* | Use | Drug | Main requirements | Approval | | --- | --- | --- | --- | | Weight management alone | Wegovy, Zepbound | Excluded | None | | Type 2 diabetes | Ozempic, Trulicity, Victoza, Rybelsus, Mounjaro and others | Diabetes diagnosis; A1C result from the past 180 days | 1 year | | Heart attack and stroke risk | Wegovy injection or tablet | Age 18+; BMI 27+; past heart attack, stroke or symptomatic artery disease, or specialist-verified heart disease; cardiologist or vascular specialist; no diabetes; lifestyle counseling | 6 months, renewals 6 months | | MASH with stage 2 or 3 fibrosis | Wegovy | Age 18+; biopsy, FibroScan or MRE records; no other GLP-1 | 6 months, renewals 12 months | | Moderate to severe sleep apnea | Zepbound | Age 18+; sleep study with 15+ events an hour, or 5+ with symptoms; BMI over 30; ongoing CPAP or BiPAP unless not indicated; no diabetes | 6 months, renewals 6 months | ## Who qualifies for Wegovy for heart disease in Nevada? An adult with a BMI of 27 or more and established heart disease, shown by a past heart attack, a past stroke of either kind, or artery disease in the legs that causes symptoms.[1] For the leg route the manual accepts an ankle-brachial index under 0.85 at rest with pain on walking, a past artery procedure, or an amputation from artery disease. It also accepts other heart disease if a specialist confirms it and explains why Wegovy fits the patient’s risk.[1] This is the strictest of Nevada’s three routes. A cardiologist or vascular specialist must prescribe it or be consulted, the record must show personal healthy-lifestyle counseling, and the patient can have neither type of diabetes.[1] People with diabetes are told to get diabetic care with another drug. Each approval lasts six months, and renewal requires reaching the 2.4 mg weekly injection dose, or 25 mg daily for the tablet, unless the prescriber explains why the injection dose is not right.[1] The label covers adults with established heart disease and either obesity or overweight.[11] ## Does Nevada Medicaid cover Wegovy for MASH? Yes, and with fewer conditions than the heart route. The adult needs stage 2 or 3 fibrosis confirmed by a liver biopsy, a FibroScan or magnetic resonance elastography, with the records attached, and must not be on another GLP-1.[1] The Wegovy MASH criteria contain no diabetes exclusion and no specialist requirement, so a person with type 2 diabetes and qualifying liver disease is not shut out of this route.[1] The first approval runs six months and renewals run 12, with a positive response and the 2.4 mg maintenance dose, or 1.7 mg if the higher dose was not tolerated.[1] Nevada also puts Wegovy ahead of Rezdiffra, the other MASH drug: Rezdiffra needs a failed or unsuitable Wegovy trial, or a specialist’s reason to expect Wegovy to fail.[1] The FDA approved Wegovy for MASH on an accelerated basis.[11] Our page on [what GLP-1s do in fatty liver disease](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers the evidence. ## What does Nevada require for Zepbound and sleep apnea? An adult with obesity and moderate to severe sleep apnea, shown in one of three ways.[1] The usual one is a study from a certified or accredited sleep facility recording 15 or more obstructive events an hour. A count of five or more also qualifies when at least one symptom is present, such as daytime sleepiness, fatigue, insomnia, waking up gasping, snoring noticed by a bed partner, or observed pauses in breathing.[1] A person too ill or immobile for a facility study can qualify if a board-certified sleep specialist or lung doctor makes the diagnosis.[1] The BMI must be over 30, the patient must not have diabetes, and the prescriber attests to a reduced-calorie diet and more activity.[1] On CPAP, Nevada asks for something different from many states. It wants the patient fully compliant with ongoing CPAP or BiPAP, unless the provider explains why that treatment is not indicated, rather than proof that CPAP failed.[1] Approvals and renewals each last six months, and renewals need a positive response and continued device use.[1] The label limits this use to adults with obesity.[10] Our guide to [Zepbound’s sleep apnea trials](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) explains how the drug was studied with and without CPAP. ## Does Nevada Medicaid cover Ozempic and Mounjaro for diabetes? Yes, with prior authorization. On the drug list effective November 1, 2026, Mounjaro, Ozempic injection, Ozempic tablet, Rybelsus, Trulicity and Victoza are preferred, and only one preferred drug has to be tried before a non-preferred one.[5] Mounjaro moved to preferred and the Ozempic tablet was added on August 1, 2026.[6] The criteria require a type 2 diabetes diagnosis and an A1C result from the past 180 days, and approvals last a year.[1] ## How do you file, and how do you appeal a denial? Prescribers send requests to Prime Therapeutics by phone at 800-695-5526, by fax at 844-347-3202, or electronically, with the records the manual asks for.[2] Sleep study reports, imaging or biopsy results and the specialist’s note are the documents most often missing. For a fair hearing, the Nevada Medicaid Hearings Office must receive the request within 90 calendar days of the date printed on the decision notice, whether Nevada Medicaid or a managed care plan issued it; a deadline that lands on a weekend or holiday moves to the next working day.[7] Requests can be made online, by phone, by mail or in person.[7] Managed care members first appeal to their plan, and federal rules give 60 days from the denial notice for that step.[8] Our guide to [writing a GLP-1 appeal](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to include, and the [Nevada state page](https://glpwatchdog.org/states/nevada) collects the key facts. ## What are the options if Nevada Medicaid says no? For weight loss alone, paying cash is the realistic path, and [manufacturer copay cards](https://glpwatchdog.org/learn/cost-and-insurance/manufacturer-coupons-glp1) are closed to Medicaid members.[12] As of November 2026, Novo Nordisk lists $349 a month for most Wegovy pen doses and $149 for the lowest-dose Wegovy pill.[13] Lilly charges $299 for the 2.5 mg Zepbound starting dose, $399 for 5 mg and $449 for 7.5 mg and up when each refill comes within 45 days of the last.[12] Check the terms on government coverage before enrolling. Our list of [low-cost GLP-1 routes without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares the choices. ## Frequently asked questions ### Does Nevada Medicaid cover Wegovy for weight loss? No. Nevada's Medicaid Services Manual lists agents used for weight management among the drugs it will not reimburse. As of November 2026, Wegovy can be approved with prior authorization for adults who have established heart disease with a BMI from 27 up, or for MASH with stage 2 or 3 liver fibrosis. ### Does Nevada Medicaid cover Zepbound for sleep apnea? Yes, with prior authorization for adults with obesity. The sleep study must show 15 or more obstructive events an hour, or 5 or more with symptoms such as daytime sleepiness. The BMI must be over 30, the person must not have diabetes, and CPAP or BiPAP use must continue unless the provider explains why not. ### Can someone with diabetes get Wegovy for MASH in Nevada? The Wegovy MASH criteria in Nevada's manual do not exclude diabetes and do not require a specialist. They need an adult with stage 2 or 3 fibrosis shown by biopsy, FibroScan or MRE records, and no other GLP-1. The heart and sleep apnea routes do exclude diabetes. ### Do Nevada Medicaid managed care plans have different GLP-1 rules? They should not for drugs on the state list. Since January 1, 2026, Nevada has used a single preferred drug list that every Medicaid plan follows, and at least one plan adopted the state's full prior authorization criteria with it. ### How long do I have to request a Nevada Medicaid fair hearing? Nevada's hearings chapter says the Nevada Medicaid Hearings Office must receive the request within 90 calendar days of the date printed on the decision notice. Managed care members appeal to their plan first, which federal rules allow within 60 days of the denial. ## References 1. Nevada Medicaid Medicaid Services Manual, Chapter 1200: Prescribed Drugs (transmittal October 27, 2026; effective November 2, 2026). nevadamedicaid.nv.gov. 2026. https://www.nevadamedicaid.nv.gov/siteassets/content/resources/adminsupport/manuals/msm/c1200/msm_1200_26_11_02.pdf 2. Prime Therapeutics for Nevada Medicaid Nevada Medicaid and Nevada Check Up Pharmacy Manual. nv.primetherapeutics.com. 2026. https://nv.primetherapeutics.com/cms/nvm/static-assets/documents2/document/NV_Pharmacy_Manual.pdf 3. Nevada Medicaid Web Announcement 3916: Nevada Medicaid has transitioned to a Single Preferred Drug List (sPDL). medicaid.nv.gov. 2026. https://medicaid.nv.gov/Downloads/provider/web_announcement_3916_20260512.pdf 4. SilverSummit Healthplan Nevada Medicaid single PDL FAQ. silversummithealthplan.com. 2025. https://www.silversummithealthplan.com/content/dam/centene/Nevada/Notifications/2025-documents/NV%20Medicaid%20Single%20PDL%20FAQ.pdf 5. Nevada Medicaid Nevada Medicaid and Nevada Check Up Preferred Drug List, effective November 1, 2026. nv.primetherapeutics.com. 2026. https://nv.primetherapeutics.com/cms/nvm/static-assets/documents2026/sssb/pdl/NV_PDL_11_01_2026.pdf 6. Nevada Medicaid Web Announcement 3976: Silver State Scripts Board changes to the Preferred Drug List effective August 1, 2026. medicaid.nv.gov. 2026. https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3976_20260731.pdf 7. Nevada Medicaid Medicaid Services Manual, Chapter 3100: Hearings (August 26, 2026). nevadamedicaid.nv.gov. 2026. https://www.nevadamedicaid.nv.gov/siteassets/content/resources/adminsupport/manuals/msm/c3100/msm_3100_26_08_26.pdf 8. Code of Federal Regulations 42 CFR 438.402: General requirements (managed care grievances and appeals). eCFR. 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-F/section-438.402 9. United States Code 42 U.S.C. §1396r-8: Payment for covered outpatient drugs (Social Security Act §1927). Legal Information Institute, Cornell Law School. 2026. https://www.law.cornell.edu/uscode/text/42/1396r-8 10. Eli Lilly and Company ZEPBOUND (tirzepatide) injection: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b 11. Novo Nordisk WEGOVY (semaglutide) injection and tablets: prescribing information. DailyMed. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b 12. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 13. Novo Nordisk Wegovy savings offer and self-pay pricing. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html --- Cite as: GLP Watchdog, Nora Bissett, "Does Nevada Medicaid Cover Wegovy or Zepbound? Heart, MASH and Sleep Apnea Routes", published 2026-11-06. https://glpwatchdog.org/research/nevada-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/nevada-medicaid-glp1-coverage Medical disclaimer: Nothing here is medical advice. We report on this subject; we do not treat anyone. Whether to begin a medication, supplement, or treatment, whether to adjust it, and whether to stop are questions for a clinician licensed to answer them, who knows your history.