In August 2025, the FDA approved Wegovy to treat MASH: metabolic dysfunction–associated steatohepatitis, commonly known as fatty liver disease. This was great news for many with the disease, offering new hope to improve liver inflammation and fibrosis.

So while there’s a reason to be optimistic if you’ve been prescribed Wegovy for fatty liver, you probably also have questions. Two of the most common ones are 1. Will my insurance cover it? and 2. What do I do if coverage is denied?

You’re not alone. Denials are common right now because many insurers still apply broad GLP-1 rules, or haven’t fully updated workflows for this newer liver indication. The good news: many of these denials are worth appealing, and patients often get to “yes” with a strong request and the right information.

Wegovy (semaglutide 2.4 mg) is FDA-approved to treat noncirrhotic MASH with moderate-to-advanced fibrosis (F2–F3) in adults, used alongside diet and physical activity. It’s the first and only GLP-1 therapy approved specifically for MASH.

Quick answers: Wegovy + fatty liver (MASH) insurance

Q: Does insurance cover Wegovy for fatty liver (MASH)?

A: Some insurance plans cover Wegovy for fatty liver disease when it’s prescribed for MASH, but coverage usually requires prior authorization. Your provider may need to submit documentation showing your MASH diagnosis and fibrosis stage (often F2–F3), along with supporting test results and clinical notes. If insurance denies your request, don’t stop there. Many people are able to win coverage by submitting an appeal – especially when the denial is based on a blanket GLP-1 policy or criteria that hasn’t caught up yet. 

Q: What do I do if insurance denies Wegovy for fatty liver (MASH)?

A: If insurance denies Wegovy for fatty liver (MASH), start by getting the denial letter and noting the exact reason for denial (you may see language like “not medically necessary” or “not on formulary”). Then submit an appeal that includes documentation of your MASH diagnosis, your fibrosis staging, supporting test results, and (optional but recommended) a letter of medical necessity from your doctor explaining why Wegovy is being prescribed for MASH. If needed, request a second review or escalate to external/independent review. 

If you get denied, save this quick overview of the process.

1. Save the denial letter.
2. Identify the reason you were denied.
3. Gather documentation to support your case.
4. Submit the right next move based on your denial reason. 
5. Escalate to a second or external review if needed.

• Escalate to second-level and then external review if needed. 

Not sure why you were denied or what the best next step is? Claimable can guide you through the appeals process step-by-step. Get started here.

Insurance denied Wegovy for fatty liver? Here’s what to do (Step by Step)

Step 1 — Read the denial reason and appeal instructions

Before you do anything else, locate:

• The reason you were denied (often under “Why your request was denied”)
• Appeal instructions (where to send it and how—fax, mail, or portal upload)

Tip: You might see a portal message before the formal letter arrives. You usually don’t need to wait—log in to your insurer’s member site and look for appeals instructions. 

Step 2 — Identify why you were denied

Most denials for Wegovy + MASH fall into buckets like these:

• Prior authorization incomplete: missing fields, missing attachments, or missing test results.
• Not medically necessary / does not meet criteria: the plan says the documentation didn’t prove you qualify (often a fibrosis staging issue).
• Not on formulary / non-formulary: the plan doesn’t list Wegovy as covered for this use, or requires an exception path.
• Not a covered benefit / “weight loss drugs excluded”: the plan is treating the request like obesity coverage—even if your prescription is for MASH.
• Alternative required / step edit: the plan wants a different option first, or wants a rationale for why alternatives aren’t appropriate (this varies a lot by plan).

The key: many of these are fixable once you match your response to the specific denial reason.

Step 3 — Choose the right next action

Use this as your decision tree:

• If it’s missing info → ask your provider to correct and resubmit the PA with a complete packet.
• If it’s criteria/medical necessity → confirm you meet criteria and file an appeal. A clinician letter of medical necessity helps here. If your insurer’s criteria isn’t aligned with clinical or FDA guidelines, Claimable can help make the case that you shouldn’t be held to unreasonable requirements. 
• If it’s formulary → appeal and request a formulary exception. Since Wegovy is the only GLP-1 that’s approved for MASH, you should qualify for a formulary exception.
• If it’s an exclusion / “weight loss only” → ask your clinician to ensure the request is clearly for MASH and not miscoded as “weight management.” If denied again, appeal and make the case that the MASH indication is being overlooked.

Wegovy for fatty liver (MASH): Coverage overview

Does insurance cover Wegovy for fatty liver disease? Sometimes, yes—but it’s usually not automatic.

“Coverage” typically depends on:

• Whether Wegovy is on your plan’s “formulary” or list of covered drugs
• Whether you meet prior authorization criteria, and
• Whether the required documentation is submitted correctly the first time.

Also important: “fatty liver” is a broad term. Wegovy’s liver indication is for MASH with moderate-to-advanced fibrosis (F2–F3) in adults without cirrhosis—so if documentation only says “fatty liver” without staging, reviewers may deny because they can’t confirm you meet the labeled criteria. 

What insurers often require to cover Wegovy for MASH (examples)

Requirements vary by plan, but common criteria include:

1) Proof of the right diagnosis + stage

Many plans look for:

• Noncirrhotic MASH
• Fibrosis stage F2 or F3
• Confirmation via biopsy or accepted noninvasive tests (some policies specify a timeframe, like within the last 180 days). 

2) Specialist involvement

Some policies require Wegovy to be prescribed by (or in consultation with) a gastroenterologist/hepatologist. 

3) Safety/eligibility checks

You may see requirements like:

• Adult age threshold (often ≥18) 
• Confirmation you don’t have cirrhosis or other excluded liver disease causes 
• Attestation about certain concurrent medications (plan-specific) 

Tip: a surprising number of denials happen because the information exists—but it isn’t included in the PA packet, or the fibrosis staging isn’t easy for the reviewer to find.

Common denial reasons and what to do about them

Denials are confusing. Here’s a breakdown of the most common denial reasons, what they look like in communications from your insurance, and how to fix it. Need help figuring out why you were denied and which strategy is right? Use Claimable's guided appeals tool to make it easy.

1) Prior auth incomplete / missing documentation

What it looks like: “Insufficient information,” “missing documentation,” “clinical records not provided.”
Fastest fix: Ask what was submitted, then resubmit with a complete packet (see checklist below). (Some plans explicitly require staging documentation.) 

2) “Not medically necessary” / “does not meet criteria”

What it looks like: “Not medically necessary,” “does not meet criteria.”
Fastest fix: Appeal and show, point-by-point, that you meet criteria (especially noncirrhotic MASH + F2–F3), citing the test that confirms staging and attaching the relevant pages. 

3) Not on formulary

What it looks like: “Not covered,” “non-formulary,” “preferred alternatives required.”
Fastest fix: Appeal and request a formulary exception. These typically require your prescriber to submit a supporting statement that the non-formulary medication is medically necessary. 

4) Benefit exclusion / “weight loss medications excluded”

What it looks like: “Plan excludes weight-loss drugs,” “not a covered benefit.”
Fastest fix: This is where diagnosis clarity matters. If the insurer is applying a weight-loss exclusion to a MASH prescription, your appeal should explicitly explain the indication and include staging evidence and your clinician’s rationale. 

5) Alternative required / “step edit”

What it looks like: “Must try X first,” “step therapy.”
Fastest fix: Address alternatives directly. Today, MASH also has other FDA-approved treatment options (for example, resmetirom/Rezdiffra is FDA-approved for noncirrhotic MASH with F2–F3). Some plans may want to understand why an alternative isn’t appropriate for you—or why Wegovy is the right option for your clinical situation. 

How to get insurance to cover Wegovy for fatty liver (MASH) — before you deal with a denial

What to ask your insurer

Call the number on your insurance card and ask:

• Is Wegovy covered for MASH (fatty liver/NASH) under my plan? 
• Is it on formulary? If not, what’s the formulary exception process?
• What are the prior authorization criteria (and can you send them to me)?
• What proof of F2–F3 fibrosis is accepted (biopsy vs elastography/MRE, etc.)?
• Is a hepatologist/gastroenterologist required?
• Where should the PA be submitted (portal/fax), and what are typical timelines?
• What qualifies for expedited review if my clinician believes delay is risky? 

What to ask your provider

Ask your clinician’s office to confirm the PA includes:

• MASH diagnosis (and “fatty liver” context, if that’s how it appears in chart history)
• Fibrosis staging (F2–F3 if applicable) + the test that supports it (attach the report)
• Confirmation of noncirrhotic status (and any relevant exclusions)
• A brief rationale tied to the plan’s criteria (not generic)
• Correct diagnosis coding and the right chart notes attached

Common submission mistakes to avoid

• Using only “fatty liver” language with no mention of MASH and no fibrosis stage
• Missing the fibrosis staging report attachment
• Generic chart notes that don’t address the plan’s criteria
• Mislabeling the request as “weight management” instead of a liver indication

How to write a Wegovy for MASH appeal

The strongest appeals mirror the denial reason:

1. Quote the denial reason (one sentence)
2. Respond directly with the evidence that answers it
3. Attach the documents and flag exactly where you’re citing it

What to include in your appeal packet

• Denial letter + reference number
• The plan’s criteria (if you have it)
• Fibrosis staging documentation (test report or biopsy summary)
• Relevant clinic notes
• Letter of Medical Necessity (recommended): diagnosis, staging, why Wegovy is appropriate for MASH, why delay is harmful, and why alternatives aren’t appropriate (if relevant). Get our template here!

If it’s a formulary appeal

• Clearly state this is a formulary exception request
• Include your prescriber’s supporting statement explaining medical necessity 

Request a second review (internal escalation)

If your first appeal is denied, request a second-level internal appeal (if your plan offers it). Make sure you address the new denial rationale directly.

External/independent review (when internal appeals fail)

For many plans, after a final internal denial you may be eligible for external review, where an independent reviewer decides the outcome—and the insurer must accept that decision. 

If your plan still won’t cover it

If you’ve exhausted your plan’s pathways, you can still explore:

• Employer benefits escalation (HR/benefits teams can sometimes clarify exceptions or push corrections)
• Manufacturer resources/savings programs (eligibility varies)
• Working with your clinician on interim management options while coverage is sorted (don’t delay care)

How Claimable helps

Navigating insurance is hard—especially when the denial reason doesn’t match your actual condition. Claimable helps you:

• Identify the most likely reason for denial
• Generate an appeal letter aligned to your denial reason and plan pathway
• Organize and submit the right documentation
• Escalate to the next level if the first appeal is denied

Start your Wegovy appeal with Claimable.

FAQs

What do I do if insurance denies Wegovy for fatty liver (MASH)?

Start by getting the denial letter and noting the exact reason (common language includes “not medically necessary” or “not on formulary”). Then appeal with a complete packet: MASH diagnosis, fibrosis staging evidence, supporting test results, and a clinician letter of medical necessity. If needed, request external review after final internal denial. 

Why did insurance deny Wegovy for fatty liver?

Common reasons include missing PA documentation, inability to confirm MASH + fibrosis stage, non-formulary status, or the request being treated under a broad GLP-1/weight loss exclusion instead of a liver indication. 

What does “not medically necessary” mean here?

It usually means the plan believes the documentation didn’t prove you meet criteria. Your appeal should focus on supplying the exact missing evidence (often fibrosis staging) and making it easy to verify. 

What is a formulary exception and when should I request one?

A formulary exception is a request for coverage when a medication isn’t on your plan’s formulary, or when you need a plan rule waived. These often require a prescriber’s supporting statement explaining medical necessity. 

Can I appeal if my plan says weight-loss drugs are excluded?

Often, yes—especially if the denial is misapplying a weight-loss exclusion to a MASH prescription. Your appeal should clearly frame the request as MASH treatment and include fibrosis staging documentation. 

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