Does Medicare cover Wegovy?

Wegovy (semaglutide) is a prescription injection prescribed for chronic weight management. The U.S. Food and Drug Administration (FDA) approved Wegovy for adults and children 12 years and older who have a body mass index (BMI) of 30 or higher or who have a BMI of 27 or higher with a related medical condition, such as high blood pressure, Type 2 diabetes, or high cholesterol. The manufacturer, Novo Nordisk, recommends that people use the medication in combination with a reduced-calorie meal plan and physical activity to sustain a healthy body weight. 

Wegovy can be pricey without insurance or coupons. The list price of Wegovy—the original price the manufacturer sets before applying any discounts or rebates—is $1,349.02 per box of four pens, which is a one-month supply. Although some health insurance policies may cover Wegovy for weight loss, Medicare doesn’t. However, some legislators are pushing to change that.  

Understanding Medicare and Wegovy

Medicare has four parts to it, each offering coverage for different medical needs. Medicare Part D is the part that covers prescription drugs. Although Medicare regulates what drugs Part D plans should cover, each plan has its own list of what drugs are covered. Medicare prohibits Part D plans from covering certain medications.

“Currently, Medicare does not cover drugs that are FDA-approved for weight management, including Wegovy,” says Sarah Bonza, MD, hospitalist at Fairfield Medical Center in Lancaster, Ohio, and founder of Bonza Health. 

Obesity wasn’t considered a medical condition when the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 went into effect in 2006, thus establishing Medicare Part D. However, legislators are trying to change that with the Treat and Reduce Obesity Act of 2023. If passed, the bill would expand Medicare coverage for obesity and allow Medicare Part D plans to cover drugs like Wegovy.

How much does Wegovy cost?

Although the list price for Wegovy is $1,349.02, it varies by pharmacy and other factors, such as supply. “High demand plus low supply equals high cost according to basic economics,“ says Angela Fitch, MD, the chief medical officer at Knownwell and the President of the Obesity Medicine Association based in Needham, Massachusetts. 

“Most people with insurance coverage and without a high deductible pay $25 or less,” Dr. Fitch explains. “If they have a deductible, they pay $1,000 per month until they reach the deductible.” 

Alternative options if Medicare doesn’t cover Wegovy

Until Medicare covers Wegovy, there are other options you can pursue to make it more affordable.

Novo Nordisk’s Patient Assistance Program

Some pharmaceutical companies offer programs to help people lower the costs of prescription drugs. Novo Nordisk offers the Novo Nordisk Patient Assistance Program (PAP) for people with Type 2 diabetes—one of the weight-related conditions Wegovy is approved for in patients with a BMI of 27 or higher. This program provides free medication to patients who meet its eligibility criteria.

Before applying, make sure you meet the following requirements:

• Be a United States citizen or legal permanent resident
• Have a total household income that is at or below 400% of federal poverty
• Be a Medicare beneficiary or have no insurance
• Not be an enrollee or qualify for other federal, state, or government health programs, including Medicaid, Low Income Subsidy, or Veterans Affairs

To apply for the patient assistance program, you must complete an online or paper application. If you have questions about the application or need assistance, you can call Novo Nordisk at 866-310-7549.

In addition to the patient assistance program, the pharmaceutical company also offers a Wegovy savings discount card, although Medicare enrollees are ineligible.

Affordable pharmacy options

Another way to get affordable Wegovy is by using a SingleCare prescription discount card. This free savings card can help you save money on Wegovy across major pharmacies. You can download the SingleCare app and show your pharmacist a digital coupon or print a paper copy to show your pharmacist. A SingleCare discount card can offer a lower cost than some Medicare Part D plans for certain drugs.