Does HUSKY Cover Wegovy? Approved Conditions and Exclusions

HUSKY Health does cover Wegovy, but only for two specific medical conditions and never for weight loss by itself. As of late 2025, Connecticut’s Medicaid program will pay for Wegovy when it is prescribed to reduce the risk of serious cardiovascular events in adults with established heart disease, or to treat a specific form of fatty liver disease called metabolic-associated steatohepatitis. Both uses require prior authorization, and a prescription written purely to help a patient lose weight will be denied.

The Two Conditions HUSKY Will Cover

HUSKY began covering Wegovy on February 3, 2025, for adults 18 and older with established cardiovascular disease who need to reduce the risk of a heart attack, stroke, or cardiovascular death.¹ That matches the FDA approval Wegovy received in March 2024 after a trial of more than 17,600 participants showed a meaningful drop in serious cardiac events compared with placebo.²

On November 3, 2025, HUSKY added a second covered indication: metabolic-associated steatohepatitis, a progressive form of fatty liver disease. Coverage applies to adults with histologically documented steatohepatitis, a liver fibrosis stage of F2 or F3, and a NAFLD Activity Score of 4 or higher, along with other clinical criteria.³

Every covered prescription must include a diagnosis code pointing to one of these two indications. Claims without the right code are denied automatically.

What HUSKY Will Not Pay For

Wegovy prescribed to treat obesity or help a patient lose weight is not a covered benefit under HUSKY, even though the FDA has approved the drug for chronic weight management in adults with obesity or overweight.² The exclusion fits the broader HUSKY pharmacy benefit, which generally does not cover drugs prescribed for obesity.⁴

Two other exclusions matter. Wegovy will not be covered for patients with Type 1 or Type 2 diabetes, and in the cardiovascular context it will not be covered for patients with the most severe form of heart failure.³

What Your Doctor Has to Document

The clinical bar for approval is high, and it is different for each indication. Your provider submits a prior authorization form, and must resubmit annually for continued coverage.

For Cardiovascular Risk Reduction

You must have a documented history of heart attack, stroke, or symptomatic peripheral arterial disease. Your hemoglobin A1c has to be 6.5% or higher, your BMI has to be below 27, and you must be participating in a lifestyle program that includes diet changes, exercise, and behavioral therapy. To continue past the first year, you must show at least 5% weight loss from your starting weight.⁵

For Metabolic-Associated Steatohepatitis

You need biopsy-confirmed steatohepatitis with stage F2 or F3 fibrosis, a NAFLD Activity Score of at least 4, no hepatic decompensation (or a MELD score of 12 or lower), and liver enzyme levels no more than five times the normal range. Other causes of chronic liver disease must be ruled out, alcohol consumption must be limited, your A1c must be below 9.5%, and you must be actively engaged in lifestyle interventions.⁶

If you do not meet every standard criterion, your provider can submit a Letter of Medical Necessity for individual review. Approval is not guaranteed.

Which HUSKY Programs Include Wegovy

The November 2025 provider bulletin lists coverage under HUSKY A, C, and D.³ The earlier February 2025 bulletin for the cardiovascular indication listed all four programs, including HUSKY B.¹ Here is what the categories mean:

HUSKY A: Medicaid for children, 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 65 and older and people with disabilities.
HUSKY D: Medicaid for low-income adults 19 to 64 without dependent children.⁷

Members in HUSKY A, C, and D have no out-of-pocket cost for covered prescriptions.⁴

Why Weight-Loss Coverage Is Excluded

The weight-loss exclusion is 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 for the treatment of obesity, along with bariatric surgery and nutritional counseling.⁸ Advocates read that to include GLP-1 drugs like Wegovy. The Lamont administration took the position that the law required coverage of weight-loss services generally but did not mandate any specific class of drug.

Cost is the backdrop. In fiscal year 2024, GLP-1 drugs cost Connecticut’s Medicaid program $85 million after rebates, consuming 35% of the entire annual pharmaceutical budget, after prescription volume grew more than 500% between 2019 and 2023.⁸ Some of that spending had gone to GLP-1s prescribed for weight loss through what DSS described as a “bureaucratic oversight.” In early 2025, the state notified physicians that patients receiving GLP-1s solely for weight loss would lose coverage, with a cutoff eventually set at July 31, 2025.⁹ In place of GLP-1s, DSS sought federal approval to cover two older, less expensive weight-loss drugs, orlistat and phentermine, and began covering dietitian-nutritionist services.¹⁰

Legislation that would explicitly require Medicaid coverage of GLP-1s for patients with a BMI of 35 or higher was introduced in the 2025 session as Senate Bill 1474, but it had not advanced beyond the Committee on Human Services as of the most recent available information.¹¹ Until that or similar legislation becomes law, the weight-loss exclusion stands.

Other GLP-1 Drugs HUSKY Covers

Wegovy is one of several GLP-1 medications on the HUSKY formulary, each tied to a specific diagnosis. As of December 2025, the program covered Ozempic, Trulicity, and Victoza for Type 2 diabetes, and Zepbound for moderate-to-severe obstructive sleep apnea in patients with obesity.¹² Zepbound coverage for sleep apnea took effect July 1, 2025, and applies to all four HUSKY programs.¹³ None of these drugs are covered when prescribed exclusively for weight loss.

If Your Prescription Is Denied

Start with your provider. They can submit a Letter of Medical Necessity for individual review, which is often the fastest path when a patient does not meet every standard criterion but has a strong clinical case.

If the denial stands, you have the right to request a fair hearing through the Department of Social Services. The request must be filed within 60 days of the date on the denial notice, either by using the hearing request form attached to the notice or by sending a signed letter to the DSS hearing office that includes your name, address, identification number, and the decision you are appealing.¹⁴ If you file before the effective date of the denial, benefits may continue while the appeal is pending.

For help understanding why a claim was denied or what documentation to gather, call the Pharmacy Client Assistance Center at 1-866-409-8430.⁴

1
Scribd. GLP-1 DSS Bulletin 2025-04 Wegovy
2
U.S. Food and Drug Administration. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults With Obesity or Overweight
3
CT DSS Map. Provider Bulletin 2025-54: Wegovy Coverage for MASH and MACE
4
Connecticut Department of Social Services. HUSKY Health Pharmacy
5
CT DSS Map. Wegovy for MACE Risk Reduction Prior Authorization Form
6
CT DSS Map. Wegovy for MASH Prior Authorization Form
7
Access Health CT. Eligibility for Medicaid, HUSKY Health, CHIP
8
CT Mirror. CT GLP-1 Weight Loss Drug Coverage
9
CT DSS Map. Provider Bulletin 2025-31
10
Connecticut Department of Social Services. SPA 25-0014: New Coverage for Obesity Medications
11
Connecticut General Assembly. Raised Bill No. 1474
12
Connecticut General Assembly. DSS Presentation, December 2025
13
CT DSS Map. Provider Bulletin 2025-32: Zepbound for Obstructive Sleep Apnea
14
Connecticut Department of Social Services. Requesting a Hearing