{"id":627848,"date":"2024-04-17T13:17:43","date_gmt":"2024-04-17T17:17:43","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627848"},"modified":"2025-10-21T14:06:27","modified_gmt":"2025-10-21T18:06:27","slug":"does-medicare-cover-wegovy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-wegovy\/","title":{"rendered":"Does Medicare cover Wegovy?"},"content":{"rendered":"

Wegovy<\/span><\/a> (semaglutide) is a prescription injection prescribed for chronic weight management. The Food and Drug Administration (FDA) <\/span>approved<\/span> 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.\u00a0It\u2019s also approved to lower the risk of cardiovascular events in adults with a BMI of 27 or higher and known heart disease.<\/span>\u00a0The 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.\u00a0<\/span><\/p>\n

Wegovy can be pricey without insurance or coupons. When it comes to using Medicare to pay for Wegovy, coverage depends on the condition you\u2019re using it for. <\/span><\/p>\n

Is Wegovy covered by Medicare?<\/span><\/h2>\n

Medicare typically only covers medication when it\u2019s prescribed for an FDA-approved indication. Since Wegovy is approved to reduce cardiovascular risk in adults with established heart disease and a BMI of 27 or higher, Medicare will cover it for that purpose. However, things get more complicated when it comes to getting Medicare to cover Wegovy for weight loss. Even though weight loss is an FDA-approved indication, Medicare doesn\u2019t cover weight loss drugs. However, some legislators are pushing to change that.\u00a0 <\/span><\/p>\n

Understanding Medicare and Wegovy for weight loss<\/span><\/h2>\n

Medicare has four parts to it, each offering coverage for different medical needs. <\/span>Medicare Part D<\/span><\/a> 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.<\/span><\/p>\n

\u201cCurrently, Medicare does not cover drugs that are FDA approved for weight management, including Wegovy,\u201d says <\/span>Sarah Bonza, MD<\/span><\/a>, hospitalist at Fairfield Medical Center in Lancaster, Ohio, and founder of <\/span>Bonza Health<\/span><\/a>.\u00a0<\/span><\/p>\n

Obesity wasn\u2019t considered a medical condition when the <\/span>Medicare Prescription Drug, Improvement, and Modernization Act of 2003<\/span><\/a> went into effect in 2006, thus establishing Medicare Part D. However, legislators are trying to change that with the <\/span>Treat and Reduce Obesity Act of 2023<\/span><\/a>. If passed, the bill would expand Medicare coverage for obesity and allow Medicare Part D plans to cover drugs like Wegovy.<\/span><\/p>\n

How much does Wegovy cost?<\/span><\/h2>\n

The average retail price of Wegovy<\/a> is $1,847 per box of four pens, which is a one-month supply. However, the price varies by pharmacy, location, and supply. \u201cHigh demand plus low supply equals high cost according to basic economics,\u201c says <\/span>Angela Fitch, MD<\/span><\/a>, the chief medical officer at <\/span>Knownwell<\/span><\/a> and the President of the Obesity Medicine Association based in Needham, Massachusetts.\u00a0<\/span><\/p>\n

\u201cMost people with insurance coverage and without a high deductible pay $25 or less,\u201d Dr. Fitch explains. \u201cIf they have a deductible, they pay $1,000 per month until they reach the deductible.\u201d\u00a0<\/span><\/p>\n

RELATED: Does Kaiser cover Wegovy?<\/a>\u2502<\/b>Does Aetna cover Wegovy?<\/b><\/a><\/strong><\/p>\n

Alternative options if Medicare won’t cover Wegovy<\/span><\/h2>\n

Until Medicare covers Wegovy, there are other options you can pursue to make it more affordable.<\/span><\/p>\n

Pharmacy discount cards<\/span><\/h3>\n

An easy way to get affordable Wegovy is by using a <\/span>SingleCare prescription discount card<\/span><\/a>. 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. With a <\/span>SingleCare coupon for Wegovy<\/span><\/a>, you could save over $600 per month.<\/span><\/p>\n

Novo Nordisk’s Patient Assistance Program<\/span><\/h3>\n

Some pharmaceutical companies offer programs to help people lower the costs of prescription drugs. Novo Nordisk offers the <\/span>Novo Nordisk Patient Assistance Program (PAP)<\/span><\/a> for people with Type 2 diabetes\u2014one 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.<\/span><\/p>\n

Before applying, make sure you meet the following requirements:<\/span><\/p>\n