Medicaid coverage
Texas: what Medicaid covers
Texas publishes the whole prior-authorization decision tree rather than a summary, so a reader can follow it themselves. For Wegovy there are two diagnoses in it, cardiovascular disease and MASH, and every other branch ends in a denial. Cardiovascular disease also requires a separate diagnosis of obesity or overweight in the last 730 days.
| Drug | Position | Criteria |
|---|---|---|
| Semaglutide | Other indications only | The published decision tree has two diagnoses in it: cardiovascular disease, and MASH at stage F2 to F3. Every other branch denies |
| Tirzepatide | not checked | Texas publishes a criteria guide per drug. The Zepbound guide was not located |
| Liraglutide | not checked | Texas publishes a criteria guide per drug. The Saxenda guide was not located |
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Semaglutide Other indications only
The published decision tree has two diagnoses in it: cardiovascular disease, and MASH at stage F2 to F3. Every other branch denies
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Tirzepatide not checked
Texas publishes a criteria guide per drug. The Zepbound guide was not located
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Liraglutide not checked
Texas publishes a criteria guide per drug. The Saxenda guide was not located
Sources
Every claim above is checked against the primary text, and the date is the day we last opened it.
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1
Texas Prior Authorization Program Clinical Criteria: Wegovy (Semaglutide)
Texas Health and Human Services Commission, presented to the DUR Board Primary text read and checked Checked August 25, 2026