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Wegovy Clinical Prior Authorization for New Metabolic Dysfunction-Associated Steatohepatitis (MASH) Indication

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Beginning November 24, 2025, Texas Medicaid and managed care organizations (MCOs) will require providers to get clinical prior authorization for the Wegovy MASH indication for clients who are enrolled in Medicaid fee-for-service. The Texas Drug Utilization Review (DUR) Board has reviewed and approved the clinical criteria for the Wegovy MASH indication.

Texas Medicaid has added the new Zepbound generic code numbers (56686 and 56687) to Table 6/3 (GLP-1 Receptor Antagonists) in the Wegovy clinical criteria guide.

The Vendor Drug Program (VDP) has published the latest version of the Wegovy criteria guide on the Clinical Prior Authorizations for Managed Care page of the VDP website.

Email vdp-formulary@hhsc.state.tx.us with comments or any questions.