Does Medicare cover Wegovy?

Wegovy is one of the most talked-about prescription drugs in recent years. Since its approval in 2021, the injectable medication has helped many people lose weight and lower their risk for weight-related health issues, including heart disease. But when it comes to coverage of the drug, questions abound. One common inquiry: Is Wegovy covered by Medicare?

The answer is a firm “no” if you’re taking Wegovy for weight loss, as Medicare does not cover any weight loss drugs. But if you've been diagnosed with cardiovascular disease and meet certain criteria, Wegovy might be covered under Medicare Part D. 

Here's what you need to know. 

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Whether or not Wegovy is covered by Medicare largely depends on why the drug was prescribed. Wegovy is not covered by Medicare when it’s taken for weight loss and management. But it may be covered for reducing the risk of major cardiovascular events (e.g. heart attack, stroke) in people with obesity or overweight and heart disease, subject to the details of your specific plan. 

Let’s take a closer look at each scenario. 

Does Medicare cover Wegovy for weight loss?

In a word? No. 

As a medication that treats weight loss and long-term weight management in people with obesity and overweight, Wegovy is considered an “anti-obesity medication.” Under current federal law, Medicare is not allowed to cover these types of drugs. So, if you’re taking Wegovy exclusively for weight loss and management, it’s unlikely to be covered by Medicare, and you’ll probably have to pay out-of-pocket for the medication.

Does Medicare cover Wegovy for heart disease?

Medicare Part D, in particular, may cover Wegovy for individuals with heart disease who also have obesity or overweight. 

In March 2024, the US Food and Drug Administration (FDA) approved Wegovy to reduce the risk of major cardiovascular events, such as heart attack, stroke, or death, in adults with heart disease and either obesity or overweight. This new indication allows Medicare Part D plans to cover Wegovy when prescribed to reduce cardiovascular risk. This expansion in coverage may allow over 3 million people currently on Medicare to get coverage for Wegovy.

Note that not everyone on Medicare has drug coverage. If you only have original Medicare (the red, white, and blue card), it won’t help with the cost of medications like Wegovy, even if you’re taking the medication for its cardiovascular health benefits. To get prescription drug coverage through Medicare Part D, you have to enroll. Learn more at medicare.gov. 

Yes, you will likely need prior authorization for Wegovy to be covered by Medicare. Even if you meet the criteria (an adult with heart disease and obesity or overweight), many Medicare Part D plans require prior authorization before they’ll cover Wegovy and similar GLP-1 medications. This means your healthcare provider will need to provide documentation that Wegovy is medically necessary for your condition. 

Some Medicare plans may also require you to try other treatments first—a process known as step therapy—before approving coverage for Wegovy. 

If you have Medicare Part D and want to check if your insurance plan covers Wegovy, contact your plan administrator. This is the best way to find out if your plan includes prescription drug coverage, whether prior authorization is required, and what you can expect for out-of-pocket costs. 

You can also review your plan’s formulary (a list of all drugs covered by your plan) to see if Wegovy is included. And last but certainly not least, another option is to use Ro’s GLP-1 Insurance Coverage Checker, a free and accessible online tool. All you have to do is fill out the form with the information on your insurance card, and Ro will send you a free, personalized coverage report based on their conversation with your plan. 

The cost of Wegovy with Medicare varies depending on the condition you’re taking it for and your plan coverage. 

If you’re taking Wegovy for a covered condition, such as heart disease, the cost depends on the drug’s cost tier. Often, Wegovy is classified as a Tier 3 or higher drug, which has higher out-of-pocket costs than lower-tier drugs. Tier 3 drugs can have a coinsurance as high as 25%--33%, meaning you’ll pay that percentage of the retail price for Wegovy until you meet your out-of-pocket maximum. To give you a general idea, the list price for a month's supply of Wegovy is $1,349.02, but the retail price may vary depending on your pharmacy and location.

If your plan doesn’t cover Wegovy (as is the case when Wegovy is prescribed for weight loss), you’ll have to pay out of pocket.

If your Medicare plan doesn’t include coverage for Wegovy or you don’t qualify for coverage of Wegovy (i.e. you don’t have heart disease or are taking it exclusively for weight loss), you still have options. 

First, if you and your healthcare provider agree that Wegovy is the right medication for you, you can ask your provider to submit an exception request to your plan. This would be a formulary exception since you are requesting coverage for a medication that is not included on your plan’s formulary. Once submitted, Medicare has to get back to you within 24–72 hours with their decision. 

If your exception request is denied—or if you’re okay with taking a different medication for weight loss—it’s time to talk to your healthcare provider about Wegovy alternatives. Some of these medications can cost less out-of-pocket than Wegovy. Or they may treat another condition you have that can be covered by Medicare. For example:

• Ozempic (semaglutide): Ozempic contains the same active ingredient as Wegovy but in lower dosage strengths. It's FDA-approved for managing blood sugar levels and reducing cardiovascular risk in people with type 2 diabetes. Out-of-pocket, the cost of Ozempic starts at $997.58 for a monthly Rx, which is less than Wegovy. But if you have type 2 diabetes and Medicare Part D, your plan may cover Ozempic. In a 28-week trial (around seven months), people taking 1 mg of Ozempic for type 2 diabetes lost 7% of their body weight, while those taking 2.4 mg of Wegovy lost 9.6%.

• Mounjaro (tirzepatide): Like Ozempic, Mounjaro is FDA-approved for treating type 2 diabetes. Out-of-pocket, the cost of Mounjaro starts at $1,079.77 for a monthly Rx, which is less than Wegovy. But if you have type 2 diabetes, your Medicare plan may cover Mounjaro. In a 72-week trial (about a year and a half), people with type 2 diabetes and obesity who took Mounjaro lost up to 15% of their body weight. 

• Zepbound (tirzepatide): Zepbound contains the same active ingredient as Mounjaro and comes in the same dosage strengths. But it is FDA-approved for weight loss and obstructive sleep apnea. Out-of-pocket, the cost of Zepbound starts at $1,086.37 for a monthly Rx, which is less than Wegovy. But if you take Zepbound to manage your sleep apnea, your Medicare plan may cover Zepbound. In a one-year trial, people taking Zepbound for sleep apnea lost 16.1%–17.3% more of their body weight than those who used a placebo.

If Medicare won’t cover your Wegovy prescription, there are still ways you can save on the cost of Wegovy.

• Price shop pharmacies. Call around to local pharmacies in your area and check online pharmacies to find the best price for Wegovy. (If buying online, make sure the pharmacy you use requires a valid prescription from a licensed healthcare provider, has a US-based address, and is licensed by your state board of pharmacy.)

• Order a multi-month supply. Ask your pharmacist about ordering a two- or three-month supply of Wegovy. Sometimes, these can be more cost-effective than a standard one-month fill. 

• Use a Wegovy coupon. Unfortunately, Medicare enrollees are not eligible for the official Wegovy Savings Card offered by Novo Nordisk, but you can find pharmacy discount cards on sites like SingleCare, WellRx, and Optum Perks. These Wegovy coupons can offer significant savings on Wegovy's retail price.

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Medicare coverage of Wegovy can vary. It is not covered when taken for weight loss, but if you take it for heart disease, it’s more likely to be covered. If you're hoping to get Wegovy covered through Medicare, here's what you need to remember.

• Medicare Part D plans may cover Wegovy, but only for those who have cardiovascular disease and either obesity or overweight and who are prescribed Wegovy specifically to lower their cardiovascular risk.

• Medicare coverage of Wegovy is not guaranteed and often requires prior authorization.

• To check if your Medicare plan covers Wegovy, contact your plan administrator and review your plan formulary.

• The out-of-pocket costs for Wegoy can still be high, even with coverage. Contact your plan administrator to get a better idea of how much you’ll have to pay for Wegovy.

• If your Medicare plan does not cover Wegovy, you can request a formulary exception, use Wegovy coupons to lower your out-of-pocket costs, or ask your healthcare provider about alternatives to Wegovy.