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The prior authorization requirements when diabetes is present If you have type 2 diabetes and want MassHealth to cover a GLP-1 medication (Ozempic, not Wegovy), the prior authorization pathway requires: Clinical criteria: Documented type 2 diabetes diagnosis (ICD-10 code E11.x) BMI of 27 or higher At least one obesity-related comorbidity: hypertension, dyslipidemia, cardiovascular disease, or sleep apnea HbA1c of 7.0% or higher despite current therapy Trial and inadequate response to metformin for at least 90 days (documented by prescription fill history or provider attestation) Trial and inadequate response to at least one additional oral diabetes medication (sulfonylurea, DPP-4 inhibitor, or SGLT2 inhibitor) for at least 90 days Documentation requirements: Current HbA1c lab result (within 90 days) Current weight and BMI List of prior diabetes medications with dates and reasons for discontinuation or inadequacy Treatment plan including diet and exercise counseling The prior authorization is reviewed by MassHealth's pharmacy benefit manager (currently Gainwell Technologies as of 2026)
Goal-blood sugar support
Forza:7.5mg
If you are eating less than this, you need to work closely with your health professional due to the risks of undernutrition (1)
