MASH with moderate-to-advanced liver scarring: the Part D route
Published by GLP-1 Coverage Guide · Updated · No clinician review is credited for this page.
Short answer: CMS routes noncirrhotic MASH with moderate-to-advanced liver scarring, consistent with F2–F3 fibrosis, to regular Part D. Simple fatty liver or unspecified scarring should not be treated as that diagnosis. Your clinician confirms the condition and your plan checks the product’s coverage.
Sources for the coverage rules are listed below. An update date marks a revision; it does not imply a sitewide medical review.
Check the exact diagnosis
Bring the liver specialist’s records to your prescriber. Ask whether the diagnosis is noncirrhotic MASH with F2–F3 fibrosis, or another liver condition. Do not infer eligibility or ineligibility from the phrase “fatty liver” alone.
Check coverage under the applicable indication
Wegovy injection has an FDA-labeled indication for noncirrhotic MASH with F2–F3 fibrosis in adults. The tablet label and injection label are not interchangeable. The prescriber and drug plan must confirm the product, indication, documentation and authorization requirements.
Costs depend on the Part D plan and any Extra Help eligibility. A potentially covered indication does not guarantee that every prescription is covered or that it costs less than the Bridge.
Take the full 2-minute eligibility check →
Common questions
Does simple fatty liver rule out the Bridge?
Do not assume that. The CMS routing condition is noncirrhotic MASH with moderate-to-advanced fibrosis. Ask your prescriber which diagnosis applies.
Can I assume all Wegovy formulations treat MASH?
No. Check the current form-specific prescribing information and discuss it with your prescriber.
Related
Criteria source: CMS provider criteria and coverage routes · CMS PA form · Wegovy prescribing information: injection and tablet indications