Yes, Wisconsin Medicaid does cover Ozempic when it is prescribed for type 2 diabetes. As of July 1, 2025, Ozempic is a preferred drug on the ForwardHealth Preferred Drug List, so it does not require prior authorization as long as the prescription carries an approved type 2 diabetes diagnosis code.1 The copay is $3 for most members. Ozempic is not covered for weight loss under any circumstances; members who need semaglutide for weight management must be prescribed Wegovy instead, through a separate and much stricter approval process.
The Type 2 Diabetes Diagnosis Requirement
Preferred status removes the prior authorization step, but it does not remove the diagnosis restriction that applies to every GLP-1 drug on the ForwardHealth formulary. For Ozempic to be covered at the pharmacy counter without extra paperwork, the prescription and the pharmacy claim must include an ICD-10 diagnosis code in the E11 range, which covers type 2 diabetes mellitus and its complications: diabetic nephropathy, retinopathy, peripheral neuropathy, circulatory problems, and the rest.
If the prescriber doesn’t write a diagnosis on the prescription, the pharmacy has to call the prescriber’s office to get one documented. Pharmacists are not allowed to take the diagnosis from the patient directly. If no E11-range code is submitted with the claim, ForwardHealth will kick the claim into prior authorization before it can be processed.
What You’ll Pay at the Pharmacy
Wisconsin Medicaid and BadgerCare Plus members pay a $3.00 copay for brand-name prescription drugs, which is the tier Ozempic falls into. Copays are capped at $12 per member, per provider, per calendar month, and federal law caps a member’s total monthly cost-sharing (premiums plus copays combined) at 5% of household income.
Several groups owe no copay at all:
- Children under 19
- American Indians and Alaska Natives
- Nursing home residents
- Other exempt categories defined by ForwardHealth
Pharmacies are required to ask for the copay, but they cannot refuse to fill the prescription if you can’t pay it. You still owe the money, but you leave with the medication.
If Ozempic Is Prescribed for Weight Loss
This is the point that trips people up. Ozempic and Wegovy are both semaglutide, but ForwardHealth treats them as separate drugs with separate coverage rules. Ozempic is FDA-approved for type 2 diabetes, and that is the only use ForwardHealth will pay for. A prescription written for weight loss will not be paid, regardless of the member’s BMI or health history.
For weight management, ForwardHealth covers Wegovy, Saxenda, and Zepbound as anti-obesity drugs through a dedicated prior authorization pathway, with its own form (F-00163), clinical criteria including BMI thresholds and a documented structured weight-loss effort, 183-day approval periods, and a two-attempt lifetime limit per member. If weight loss is the goal, the conversation with the prescriber needs to be about Wegovy, not Ozempic.
Why Ozempic’s Status Has Shifted
Ozempic’s place on the formulary has moved more than once. It started as non-preferred. On March 18, 2024, ForwardHealth temporarily moved it to preferred status because of supply shortages affecting other preferred GLP-1 drugs like Trulicity and Victoza. When those shortages eased, Ozempic went back to non-preferred on December 1, 2024, and prior authorization was required again, even for members who had already started it during the temporary window. The July 1, 2025 change made Ozempic preferred on an ongoing basis.
The practical takeaway: if you were on Ozempic during the earlier back-and-forth and ran into a PA requirement, that barrier is gone as long as the diabetes diagnosis is on the prescription.
If Your Prescription Needs Prior Authorization
Prior authorization comes back into the picture if the diagnosis code is missing or if Ozempic is being prescribed for something outside the approved use. When PA is required, the process starts with the prescriber, not the member.
The prescriber fills out and signs the appropriate PA form with the clinical documentation. The completed form goes to the pharmacy where the prescription will be filled, or is given to the patient to take to the pharmacy. The pharmacy then submits the PA request to ForwardHealth together with the Prior Authorization Request Form (F-11018). Submissions can go through the ForwardHealth Portal, the STAT-PA system, NCPDP transactions, fax, or mail.
ForwardHealth processes PA requests within 20 working days of receiving all the information it needs. Providers can check status through the WiCall automated system or by calling Provider Services. If you want to check on your own coverage or ask a question about a specific drug, call ForwardHealth Member Services at 800-362-3002.
BadgerCare Plus and Managed Care Plans
BadgerCare Plus is Wisconsin’s main Medicaid program for low-income residents, and its prescription drug coverage runs on the same ForwardHealth Preferred Drug List and the same prior authorization rules described above. Managed care organizations operating within Wisconsin Medicaid, including My Choice Wisconsin’s Partnership program, send members who are not enrolled in Medicare to the ForwardHealth formulary for their drug benefits. In short, the Ozempic coverage rules are the same whether you are in fee-for-service Medicaid or a managed care plan that uses the ForwardHealth drug list: preferred for type 2 diabetes with the right diagnosis code, $3 copay, no coverage for weight loss.