Does Medicare cover Wegovy?

In this article:

• Does Medicare cover Wegovy?
• Wegovy for weight loss only
• Wegovy for cardiovascular risk reduction
• Wegovy for noncirrhotic MASH
• Which Medicare plans cover Wegovy?
• What does Wegovy cost with Medicare?
• How to get Wegovy covered by Medicare
• What if Medicare doesn't cover Wegovy?
• Expert takeaway
• FAQs

In this article

• Does Medicare cover Wegovy?
• Wegovy for weight loss only
• Wegovy for cardiovascular risk reduction
• Wegovy for noncirrhotic MASH
• Which Medicare plans cover Wegovy?
• What does Wegovy cost with Medicare?
• How to get Wegovy covered by Medicare
• What if Medicare doesn't cover Wegovy?
• Expert takeaway
• FAQs

Medicare prescription drug coverage typically varies by plan, but Wegovy (semaglutide) is a special case. Wegovy is a glucagon-like peptide-1 (GLP-1) medication primarily used for weight loss and weight management. Federal law has prevented Medicare from covering weight loss medications for years, but a new program defies that rule. Now, eligible Medicare Part D beneficiaries who meet prior authorization requirements can temporarily access Wegovy for weight loss. Some Medicare Part D plans cover Wegovy for other indications as well.

Does Medicare cover Wegovy?

Medicare coverage for Wegovy depends on why it’s being prescribed (its indication) and whether Wegovy appears on your specific plan’s drug formulary.

Until July 2026, Medicare Part D plans could only cover Wegovy for reducing the risk of major adverse cardiovascular events or treating an advanced liver disease known as noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH).

Thanks to a new program, Wegovy will be available to certain Medicare recipients for weight loss or weight maintenance through 2027.

Wegovy for weight loss only

Historically, Medicare Part D prescription drug plans haven’t covered Wegovy for weight loss and weight management. Obesity has long been seen as a cosmetic issue, and federal law prevents Medicare from paying for cosmetic treatments.

Now that obesity is gaining recognition as a chronic medical condition, Medicare offers coverage for Wegovy and two other GLP-1 medications for weight loss and weight management. This coverage is offered as part of a new, temporary program called Medicare GLP-1 Bridge. Under this program, people with prescription drug coverage through Medicare Part D or Medicare Advantage can get Wegovy for a steep discount.

“The Medicare GLP-1 Bridge program represents a major paradigm shift in treating obesity from a policy standpoint,” says Michael DeShields, MD, the clinical adviser of Discovery Institute in New Jersey. “It is a significant acknowledgment that obesity should be recognized as a chronic disease, as opposed to a lifestyle choice.”

Under the Bridge program, prior authorization is required to make sure you meet coverage criteria:

• You must be at least 18 years old.
• At least one of the following must be true:
  • Your body mass index (BMI) is 35 or higher (or was 35 or higher when you first started taking a GLP-1).
  • Your BMI is 30 or higher, and you have been diagnosed with heart failure with preserved ejection fracture, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or above.
  • Your BMI is 27 or higher, and you have been diagnosed with prediabetes or symptomatic peripheral artery disease, or have previously had a heart attack or stroke.
• You must have Medicare Part D drug coverage that does not cover Wegovy. People with Type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease cannot get Wegovy under the Bridge program, since Medicare Part D may cover it for one of these uses.

The Medicare GLP-1 Bridge program is scheduled to run from July 1, 2026, to Dec. 31, 2027, although the BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive Health) is expected to provide a continuation of coverage for weight-loss drugs. GLP-1s like Wegovy are intended to be taken long-term, so your healthcare provider can help you continue to navigate coverage during this transition.

“I believe the temporary nature of the program creates uncertainty regarding continued access. Initiating patients on an effective treatment modality without guaranteed coverage raises concern for treatment interruption and potential weight gain upon loss of access,” Dr. DeShields says.

Wegovy for cardiovascular risk reduction

Wegovy was originally approved by the Food and Drug Administration (FDA) for weight loss in 2021. In March 2024, Wegovy earned FDA approval for a second indication: reducing the risk of major adverse cardiovascular events (heart attack, stroke, or death) in adults with cardiovascular disease and a BMI of 27 or higher.

Some Medicare prescription plans cover Wegovy for this indication, but some don’t.

Wegovy for noncirrhotic MASH

In August 2025, the FDA approved Wegovy for a third indication: treating a liver disease called noncirrhotic MASH. There are no federal laws preventing Medicare plans from covering Wegovy for MASH. However, Wegovy still doesn’t appear on many Medicare Part D drug formularies. Your healthcare provider may need to request Wegovy coverage on your behalf.

Which Medicare plans cover Wegovy?

Medicare only covers Wegovy through standalone Medicare Part D plans and Medicare Advantage plans with drug coverage. Wegovy isn’t covered through original Medicare (Part A and Part B).

However, specific drug coverage can vary widely from plan to plan. Confirm Wegovy coverage by viewing your plan’s drug formulary online or calling the number on your health insurance card.

If you want to switch to a new plan with Wegovy coverage, you may need to wait until the next Annual Enrollment Period.

What does Wegovy cost with Medicare?

The cost of Wegovy with Medicare varies by plan, indication, and your income.

Cost per indication

For weight loss, Wegovy costs $50 per month under the Medicare GLP-1 Bridge program. “This will greatly increase accessibility and continuity of care for patients who have historically had no viable path towards treatment,” says Dr. DeShields.

For MASH treatment or cardiovascular risk reduction, you’ll first need to meet your plan’s deductible, which ranges from $0 to $615 in 2026. Then, you’ll pay a copay or coinsurance according to your plan’s details and drug formulary.

Drug formularies sort drugs into numbered tiers, and higher numbers have more expensive copays or higher coinsurance percentages. Wegovy tends to be sorted into a higher tier. The exact cost per tier varies from plan to plan.

All Medicare Part D plans have a maximum out-of-pocket spending limit of $2,100 for the 2026 calendar year. Once you’ve spent this much on all of your covered prescriptions (including your deductible, copays, and coinsurance), your prescriptions are free for the rest of the year.

Cost for people with low income

Some people don’t have to meet the maximum out-of-pocket limit by themselves. Those with low income and low financial resources may qualify for Medicare Extra Help. This subsidy program reduces the out-of-pocket cost of brand-name medications and eliminates your Medicare Part D premium and deductible. If your Medicare D plan covers Wegovy, you would pay $12.65 under Extra Help for a one-month supply in 2026, but if you qualify for Wegovy coverage under the Bridge program, you would pay $50.

The government pays the difference on your behalf. Once you and the government have paid $2,100 toward your covered prescriptions, drug costs drop to $0 for the rest of the 2026 calendar year.

Cost of Wegovy without Medicare coverage

Wegovy can be expensive without insurance coverage. Its average retail cost is $1,805 per 30, 1.5 milligram tablets.

If your Medicare plan doesn’t cover Wegovy or your prior authorization request is denied, you don’t have to pay full price. A free SingleCare prescription discount card can lower the cost to $1,011 per 30, 1.5 milligram (mg) tablets.

A one-month supply of injectable Wegovy tends to be a little more expensive at around $1,145 per 4, 0.5 milliliter (mL) prefilled 0.5 mg/0.5 mL pens with a SingleCare coupon. The exact price depends on form, quantity, dosage, and pharmacy.

How to get Wegovy covered by Medicare

Fortunately, the Medicare GLP-1 Bridge program makes it easier for people with higher BMIs to get Wegovy. The eligibility and prior authorization requirements aren’t terribly strict, and the out-of-pocket cost is relatively low.

It may be more difficult to get Wegovy covered by Medicare for other indications, especially if Wegovy isn’t listed on your plan’s drug formulary.

In that case, your healthcare provider can submit an exception request on your behalf. They’ll explain why Wegovy is medically necessary for your treatment. Your insurance company may cover Wegovy if it agrees with the healthcare provider’s assessment.

What if Medicare doesn’t cover Wegovy?

There are several things you can do if Medicare doesn’t cover Wegovy.

• Ask your healthcare provider to submit an appeal if Medicare denies your prior authorization request.
• Ask your healthcare provider about Wegovy alternatives, like the new GLP-1 tablet Foundayo (orforglipron).
• Use a free SingleCare Wegovy coupon to lower the out-of-pocket cost.
• Consider switching to a Medicare Part D plan that covers Wegovy during the next enrollment period.

Expert takeaway

“With some Medicare plans covering GLP-1s as well as the Medicare GLP-1 Bridge program, patients are often able to get their medication at a more affordable price,” says Karen Berger, Pharm.D., member of the SingleCare Medical Review Board. “If you are interested in trying Wegovy or another GLP-1, talk to your healthcare provider about next steps.”

Frequently asked questions

Does Medicare cover Wegovy for weight loss?

Under the GLP-1 Bridge program, Medicare will temporarily cover Wegovy for weight loss from July 1, 2026, through Dec. 31, 2027, for eligible Medicare beneficiaries who meet prior authorization requirements and have prescription drug coverage. After this program ends, the BALANCE Model is expected to continue Medicare coverage for these drugs, although details are still being finalized.

What part of Medicare covers weight loss drugs?

Historically, no part of Medicare covers weight loss drugs. From July 1, 2026, through Dec. 31, 2027, a special program called Medicare GLP-1 Bridge will offer three GLP-1 weight loss medications: Wegovy, Zepbound, and Foundayo. After this program ends, the BALANCE Model is expected to continue Medicare coverage for these drugs once details are finalized.

Can you use SingleCare for GLP-1s if you have Medicare?

Yes, you can use SingleCare for GLP-1s if you have Medicare, but you cannot use SingleCare and Medicare for the same prescription. If your GLP-1 is covered under Medicare or the Bridge program, your pharmacist can help you compare the Medicare or Bridge program price with the SingleCare price.