# Does North Dakota Medicaid Cover Wegovy? The Ozempic-First Routes Explained By Nora Bissett, Pricing Editor (https://glpwatchdog.org/authors/nora-bissett) | Published: 2026-11-07 Canonical page: https://glpwatchdog.org/research/north-dakota-medicaid-glp1-coverage > North Dakota Medicaid will not pay for any GLP-1 to lose weight, yet its October 2026 drug list opens heart, MASH and sleep apnea routes with Ozempic as the preferred semaglutide. The age and BMI window, the CPAP rule, older obesity drugs and appeals. ## Key points - GLP-1s are not covered for weight loss, but phentermine, bupropion, naltrexone and topiramate need only an obesity diagnosis code. - Ozempic is the preferred semaglutide; Wegovy follows only after a tolerated 2 mg Ozempic dose. - The heart route covers ages 55 to 74 with a BMI from 27 to under 35 and no diabetes. - Sleep apnea coverage needs a sleep specialist, an in-lab AHI over 15 and six failed months of CPAP; Zepbound also needs six months of semaglutide first. - Ozempic for diabetes needs no prior authorization, and appeals are due 30 days after the notice is mailed. Not for weight loss. As of November 2026, North Dakota Medicaid’s prior authorization form says GLP-1 drugs “are not covered for weight loss/obesity,” but its drug list does pay for semaglutide to lower heart risk, to treat the liver disease MASH and, after a failed CPAP trial, for sleep apnea.[1][2] On each of those routes Ozempic is the preferred form, and Wegovy is approved only after the patient has tolerated Ozempic at 2 mg.[1] > **About this article.** This page reads North Dakota Medicaid’s Pharmacy Coverage Policy Manual, version 2026.7, effective October 1, 2026, its GLP-1 prior authorization form, and the state’s pharmacy and appeal pages, as they stood on November 7, 2026. We did not read the appeal rule in the state administrative code itself. To compare states, use the [state Medicaid GLP-1 checker](https://glpwatchdog.org/tools/state-medicaid-glp1-checker). ## Does North Dakota Medicaid cover Wegovy for weight loss? No. The state’s GLP-1 request form lists weight loss as a diagnosis only to say these drugs are not covered for it.[2] Under federal law, states may leave weight-loss drugs out of Medicaid, and North Dakota does so for GLP-1s.[5] Our explainer on [how Medicaid separates Ozempic from Wegovy](https://glpwatchdog.org/research/does-medicaid-cover-ozempic-and-wegovy) covers the federal option, and the [Medicaid coverage hub](https://glpwatchdog.org/insurance/medicaid) compares states. Older obesity drugs are another matter. Phentermine, bupropion, naltrexone and topiramate are covered without prior authorization when the prescription carries an obesity diagnosis code.[1] For weight gain caused by antipsychotic medicines, Ozempic and brand Victoza are covered without prior authorization under specific diagnosis codes, as is metformin.[1] One rule simplifies everything that follows. North Dakota carved pharmacy out of managed care on January 1, 2020, so every Medicaid member, including the expansion group, uses the same drug list and the same prior authorization vendor, Acentra Health.[3] ## Why does North Dakota prefer Ozempic over Wegovy? Its drug list treats semaglutide as one product with several brands. Ozempic injection, Ozempic tablets and Rybelsus are preferred; Wegovy injection and Wegovy tablets are non-preferred.[1] For heart risk and MASH, the state names “semaglutide” as the preferred agent and adds a step for Wegovy: a dose escalation to 2 mg of Ozempic injection “must be tolerated before Wegovy will be authorized.”[1] Wegovy is the brand with FDA approval for those two uses.[7] In practice, a patient may be treated with Ozempic for months before Wegovy enters the picture. *North Dakota Medicaid GLP-1 routes, from the Pharmacy Coverage Policy Manual effective October 1, 2026* | Use | Preferred drug | Main requirements | Approval | | --- | --- | --- | --- | | Weight loss alone | None | Not covered | None | | Type 2 diabetes | Ozempic, Rybelsus, Trulicity, brand Victoza | No prior authorization | Not required | | Type 2 diabetes, Mounjaro | Mounjaro | 90 days of triple therapy with Trulicity and Ozempic plus metformin, an SGLT-2 drug or insulin, without reaching goal | 12 months | | Lowering heart attack and stroke risk | Semaglutide (Ozempic) | Age 55 to 74; no diabetes; BMI 27 to under 35; prior heart attack, or prior stroke with leg artery disease; on cholesterol and antiplatelet drugs | 12 months | | MASH with F2 to F3 fibrosis | Semaglutide injection, brand Victoza | Endocrinologist, GI doctor or liver specialist; fibrosis stage by biopsy or imaging test | 12 months | | Moderate to severe sleep apnea | Semaglutide or tirzepatide | Sleep specialist; AHI over 15 on a lab study; BMI 30 or more; no type 2 diabetes; failed 6 months of CPAP | 12 months | ## Who qualifies for Wegovy to lower heart risk in North Dakota? A narrow group. The patient must be at least 55 and younger than 75, have a normal A1c without diabetes medicine, and start with a BMI of at least 27 but below 35.[1] The heart history must be a prior heart attack, or a prior stroke together with leg artery disease shown by claudication with an ankle-brachial index under 0.85, an artery procedure or an amputation.[1] The patient must already take a cholesterol-lowering drug and an antiplatelet drug, and a current smoker needs cessation counseling within the past year.[1] Those limits go well past the label, which covers adults with established heart disease and either obesity or overweight with no age band and no BMI ceiling.[7] A 50-year-old after a heart attack, or someone with a BMI of 38, falls outside the state’s criteria. People with diabetes are sent to the diabetes section instead, where Ozempic needs no prior authorization at all.[1] Switching to Mounjaro or the Wegovy pill on this route requires a 12-month semaglutide injection trial that failed, defined as less than 5% loss of weight or BMI, or a heart event after that loss.[1] ## Does North Dakota Medicaid cover semaglutide for fatty liver disease? Yes, with prior authorization for MASH at fibrosis stage F2 or F3. An endocrinologist, gastroenterologist or hepatologist must prescribe or consult, and the stage must come from a biopsy, a liver stiffness scan such as FibroScan, an ELF blood test, MRI-PDFF or MR elastography.[1] Anyone who has used alcohol in the past five years needs a PEth level under 20 ng/mL or two negative alcohol tests, the latest within three months.[1] Semaglutide injection and brand Victoza are preferred, and Rezdiffra sits in the non-preferred column.[1] The same 2 mg Ozempic step applies before Wegovy.[1] Renewal after 12 months needs resolution of steatohepatitis without worse fibrosis, or fibrosis improved by at least one stage.[1] Our page on [semaglutide for MASH](https://glpwatchdog.org/research/glp1-and-fatty-liver-mash) covers the accelerated approval behind this use.[7] ## Will North Dakota Medicaid cover Zepbound for sleep apnea? Only after two earlier steps. Every sleep apnea request needs a neurologist, pulmonologist, ear, nose and throat doctor or other sleep specialist; an AHI over 15 on an attended lab study, so a home test does not count; a BMI of 30 or more; and no type 2 diabetes.[1][2] The patient must also have failed six months of CPAP plus a weight management program within the past year, with the AHI still over 15.[1] For Zepbound specifically, the record must show at least six months in a weight program that included semaglutide, or phentermine if semaglutide was not tolerated.[1] North Dakota lists semaglutide for sleep apnea as well, although only Zepbound has FDA approval for that use.[1][6][7] Approvals last 12 months. Renewal needs a drop in AHI of at least 20% on a sleep study, a move to remission or mild apnea, or at least 10% weight loss with recent sleep visit notes.[1] Our guide to [Zepbound for sleep apnea](https://glpwatchdog.org/research/zepbound-for-sleep-apnea) covers the trials. ## How does a North Dakota prescriber request prior authorization? With the GLP-1 and GIP/GLP-1 agonist form from Acentra Health, faxed to 855-207-0250; questions go to 866-773-0695.[2] The form has separate sections for heart risk and sleep apnea, asking for the A1c, starting BMI, heart history, AHI and CPAP history, so a complete form is the fastest route.[2] Our walkthrough of [prior authorization and appeals](https://glpwatchdog.org/research/glp1-prior-authorization-and-appeals) covers what to attach. ## How do you appeal a denial in North Dakota? The request must be filed no later than 30 days from the date the notice was mailed, and it can be made by phone, email, fax or mail.[4] Form SFN 162 is available but not required.[4] The Appeals Supervisor in the department’s Legal Advisory Unit takes calls at (701) 328-2311 or toll-free at (800) 472-2622.[4] A denial for a missing CPAP log or a home sleep test can often be fixed by resubmitting; a denial based on age or a BMI of 35 or more on the heart route follows the written criteria and is hard to reverse.[1] ## What are the options if North Dakota Medicaid says no? Self-pay, without the Zepbound copay card, whose terms exclude anyone enrolled in Medicaid.[8] In the prices we track, Novo Nordisk sells most Wegovy pen doses for $349 a month, and Lilly’s Zepbound costs $299 at the starting dose, $399 at 5 mg and $449 at higher doses refilled on time.[8][9] Before paying, ask whether a covered drug fits: phentermine needs only an obesity diagnosis code here.[1] Our list of the [cheapest GLP-1 options without insurance](https://glpwatchdog.org/research/cheapest-glp1-without-insurance) compares the cash routes. ## Frequently asked questions ### Does North Dakota Medicaid cover Wegovy? Not for weight loss. As of November 2026 it covers Wegovy for heart risk and MASH with prior authorization, but only after the patient has tolerated Ozempic at 2 mg, because Ozempic is the preferred semaglutide on the state's list. ### Does North Dakota Medicaid cover Ozempic? Yes. Ozempic injection and tablets are preferred for type 2 diabetes with no prior authorization. Ozempic is also the preferred drug on the heart and MASH routes, and it is covered without prior authorization for antipsychotic-induced weight gain with the right diagnosis code. ### Does North Dakota Medicaid cover Zepbound for sleep apnea? With prior authorization, after a failed six-month CPAP trial and six months of semaglutide in a weight program. The patient needs a sleep specialist, an AHI over 15 on a lab sleep study, a BMI of 30 or more and no type 2 diabetes. ### What are the North Dakota Medicaid criteria for Wegovy for heart disease? Age 55 to 74, a normal A1c without diabetes medicine, a starting BMI of at least 27 and under 35, a prior heart attack or a prior stroke with leg artery disease, and current cholesterol and antiplatelet treatment. Approval lasts 12 months. ### Does North Dakota Medicaid cover phentermine? Yes. Phentermine, bupropion, naltrexone and topiramate are covered without prior authorization when the prescription includes an obesity diagnosis code. ### How long do I have to appeal a North Dakota Medicaid denial? Thirty days from the date the notice of action was mailed. The appeal can be made by phone, email, fax or mail, and the SFN 162 form is optional. ## References 1. North Dakota Department of Health and Human Services, Medical Services Division Pharmacy Coverage Policy Manual (Preferred Drug List), version 2026.7, effective October 1, 2026. ndmedicaid.acentra.com. 2026. https://ndmedicaid.acentra.com/wp-content/uploads/sites/17/2026/09/NDPDL.pdf 2. Acentra Health for North Dakota Medicaid GLP-1 Agonist and GIP/GLP-1 Agonist Prior Authorization Form. nddruglookup.acentra.com. 2026. https://nddruglookup.acentra.com/forms/GLP1_GIP_Agonist_PA_Form.pdf 3. North Dakota Department of Health and Human Services Medicaid pharmacy providers. hhs.nd.gov. 2026. https://www.hhs.nd.gov/healthcare/medicaid/provider/pharmacy 4. North Dakota Department of Health and Human Services File an Appeal (Medicaid). hhs.nd.gov. 2026. https://www.hhs.nd.gov/healthcare-coverage/medicaid/file-appeal 5. 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 6. 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 7. 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 8. Eli Lilly and Company Zepbound savings and self-pay options, with card terms. zepbound.lilly.com. 2026. https://zepbound.lilly.com/savings 9. Novo Nordisk Wegovy savings offer. novocare.com. 2026. https://www.novocare.com/obesity/products/wegovy/savings-offer.html --- Cite as: GLP Watchdog, Nora Bissett, "Does North Dakota Medicaid Cover Wegovy? The Ozempic-First Routes Explained", published 2026-11-07. https://glpwatchdog.org/research/north-dakota-medicaid-glp1-coverage Canonical HTML page: https://glpwatchdog.org/research/north-dakota-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.