Does Medicare cover Wegovy for heart disease?

When it first hit the market, Wegovy (semaglutide) was only approved for weight loss and management. Since then, however, it’s added a new indication to its resume: reducing the risk of heart attack and stroke in certain populations. Given the drug’s expanded use, it makes sense to wonder if Medicare will now cover Wegovy for heart disease—especially since the government-funded insurance typically does not cover weight loss medications. 

The short answer? Yes, Medicare Part D can cover Wegovy. But there are limitations, and Part D prescription drug plans can vary. Keep reading to learn more about whether Medicare covers Wegovy for heart disease, how much the drug might cost with coverage, and how to save if you pay for the medication. 

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

In March 2024, the US Food and Drug Administration (FDA) expanded Wegovy’s indications to include heart disease. More specifically, the agency approved the drug to reduce the risk of major cardiovascular problems, such as heart attack and stroke, in adults with heart disease and either obesity or overweight. This new indication means Wegovy may be considered a cardiovascular medication, which opens the door for  Medicare Part D to potentially cover it. Current law does not allow Medicare Part D to cover weight loss drugs, and Wegovy was previously only FDA-approved for weight loss and management in people with obesity or overweight who had at least one weight-related health condition (e.g. high blood pressure, diabetes). 

Thanks to the new indication, about 3.6 million Americans with obesity or overweight on Medicare may now be eligible for Wegovy coverage to reduce their cardiovascular risk, according to KFF. 

That said, Medicare still does not cover Wegovy when it’s prescribed for weight loss and management alone. For a medication to be covered by Medicare, it must be approved for a medically accepted indication, such as heart disease.  

Wegovy may only be covered if you have Medicare Part D, which provides coverage for prescription medications. Medicare Part B, on the other hand, does not cover Wegovy. Instead, Medicare Part B covers only diabetic medical supplies, certain medications and vaccines, and some physician-administered treatments.

If you have a Medicare Advantage or “Part C” plan (instead of Original Medicare), you should check if your plan now includes coverage of Wegovy. While these plans offer prescription drug coverage, the covered medications and costs can vary. Prior authorization may be required before your health insurance will cover Wegovy.

Why doesn’t Medicare cover Wegovy for weight loss?

Unfortunately, Medicare does not cover Wegovy for weight loss. The Medicare Modernization Act of 2003 does not allow Medicare to cover antiobesity medications like Wegovy. Wegovy can only be covered under Medicare Part D if you have a diagnosis of cardiovascular disease.

The cost of Wegovy, when covered by Medicare Part D, depends on the details of your plan, specifically the deductible and copay. Some Medicare Part D plans may classify Wegovy as a specialty or higher-tier drug, which has the highest copayment. If your plan charges coinsurance for Wegovy, you may pay $325–$430 per month for the drug, which is a portion of the drug’s $1,349.02 list price. The best way to know how much you’ll pay for Wegovy is to review your plan’s prescription drug coverage on the Medicare site here.

The Inflation Reduction Act caps the total out-of-pocket costs Medicare enrollees pay for prescription drugs. In 2024, this ranges from $3,300–$3,800. In 2025, this is capped at $2,000. Once you hit the max, you’ll pay $0 for covered Medicare Part D drugs for the rest of the year.

In clinical trials, people taking Wegovy lost an average of 9.6–16% of their body weight in about a year and a half. As many as 85% of people lost at least 5% of their body weight. This amount of weight loss on its own can lower your risk of experiencing a heart attack or other major cardiovascular event. Living with obesity raises your risk of heart disease.

In addition to promoting significant weight loss, Wegovy may further reduce cardiovascular risks by addressing inflammation associated with obesity.. For example, people with obesity typically have elevated levels of C-reactive protein (CRP). CRP levels are higher when people have inflammation or infection, and Wegovy may have an anti-inflammatory effect that reduces CRP levels in people with obesity. Losing weight also tends to lower CRP levels.

Clinical trials show that Wegovy lowers the risk of heart attack, stroke, or death from heart disease by 20%. Among people with type 2 diabetes and obesity, Wegovy may lower these risks by as much as 26%, according to an earlier 2016 study. Research suggests taking Wegovy also offers other benefits related to heart health, including improved blood pressure and cholesterol. 

Medicare does not cover Wegovy for weight loss, so if you haven’t been diagnosed with heart disease, Medicare will not cover it. At the time of writing, there is no approved generic form of Wegovy, and brand-name Wegovy costs over $1,300 per month out-of-pocket. Still, there are ways to save on Wegovy if Medicare won’t cover it. 

Price-shop at different pharmacies

Your first step is to call around to different pharmacies in your area or check the pharmacy’s website for pricing information. The list price of Wegovy is $1,349.02 for a 28-day supply, but pharmacies can charge a higher retail price for the medication. Some pharmacies may offer Wegovy for a more affordable price than others, so it’s a good idea to check.

You can also consider getting Wegovy online or through a mail-order pharmacy. And some pharmacies will offer Wegovy at a discounted price if you order a two- or three-month supply.

Look into prescription discount cards

Several websites—including GoodRx, Optum Perks, SingleCare, Drugs.com, and WellRx—offer discount cards that you can use at specific pharmacies. These can bring down the price of Wegovy significantly. For example, on GoodRx, you can save up to 20% off the retail price of Wegovy. All you need to do is select your dosage of Wegovy and your preferred pharmacy and download or print the discount card.

Novo Nordisk, the maker of Wegovy, also offers a Wegovy Savings Card. However, people with Part D coverage through Medicare are not eligible for the card. There is no Patient Assistance Program (PAP) for Wegovy at this time.

Consider Wegovy alternatives 

You can also ask your healthcare provider about other alternatives to Wegovy, which may be more affordable. Ozempic (semaglutide), for example, is another once-weekly injectable medication that contains the same active ingredient as Wegovy in lower dosage amounts. It is FDA-approved to help manage blood sugar levels and lower heart disease risks in people with type 2 diabetes. Victoza (liraglutide) is another option; it is FDA-approved for the same uses as Ozempic, but it involves a daily injection.

Ozempic costs $968.52 per month, which is about $400 less than the list price of Wegovy. Victoza can be even more affordable, with average costs ranging from $543.51–$815.27. And because neither Ozempic nor Victoza includes weight loss as one of its indications, both drugs tend to be covered by Medicare—but only if you are taking it to treat either heart disease or type 2 diabetes.

Now that the FDA has expanded Wegovy’s indications to include heart disease, the drug can be covered through Medicare Part D. Medicare still does not cover Wegovy for weight loss. If you are not taking Wegovy for heart disease (or if your Medicare plan does not cover Wegovy), you can still lower the cost of the drug by price-shopping at different pharmacies or using prescription discount cards.

---

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

November 04, 2024

Written by

Amelia Willson

Fact checked by

Patricia Weiser, PharmD

---

About the medical reviewer

Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist, health content writer, and medical reviewer with more than a decade of clinical experience in community and hospital pharmacy.