Medicaid coverage
Does Florida Medicaid cover Rybelsus?
Rybelsus (semaglutide (oral)) for type 2 diabetes — the Florida Medicaid prior-authorization rule, source-cited.
Florida Medicaid Rybelsus PA criteria
Per AHCA GLP-1 Receptor Agonist criteria (orig. eff. 10/1/2025, rev. 3/12/2026).
Preferred (clinical PA required): Mounjaro, Ozempic, Trulicity; non-preferred: Exenatide, generic liraglutide (Victoza), Rybelsus, Victoza.
Patient must be >=18 for Ozempic and Rybelsus, or >=10 for Mounjaro, Trulicity, Victoza; diagnosis of type 2 diabetes mellitus; HbA1c >=6.5% measured within the past 6 months (documentation required); trial and failure of metformin within the past 2 years unless contraindicated or intolerant (documentation required); for non-preferred agents, previous trial with insufficient response, adverse reaction, or contraindication to a preferred GLP-1.
Length of authorization up to one year; continuation requires met initial criteria + improved response (e.g., HbA1c decline) + no treatment-restricting AEs + appropriate dosing.
Source: AHCA Florida Medicaid GLP-1 Receptor Agonist and Related Agents PA Criteria (rev. 03/12/2026). View cited GLP-1 policy reference →
Frequently asked
- Does Florida Medicaid cover Rybelsus for type 2 diabetes?
- Covered with prior authorization. Per AHCA GLP-1 Receptor Agonist criteria (orig. See the full source-cited criteria above. Per AHCA Florida Medicaid GLP-1 Receptor Agonist and Related Agents PA Criteria (rev. 03/12/2026), as of 2026-03-12 (orig. eff. 10/1/2025, rev. 3/12/2026) — confirm the member's current plan policy.
d3rx does not hold plan-specific pharmacy formularies or PBM prior-auth grids, so it cannot confirm a particular plan's GLP-1 coverage, tier, or PA criteria. The guidance below is the general, source-cited rule; confirm the specific plan's pharmacy formulary / PA policy for a binding answer.
Check Rybelsus for another payer — or draft the PA
Run Rybelsus + any payer in the GLP-1 PA lookup, or have Ask D3 draft a Florida Medicaid-ready prior-authorization request with the right criteria and codes — free, no signup.