Does Medicare cover Wegovy for heart disease?

Medicare may cover Wegovy (semaglutide) for people with heart disease and obesity or overweight, though coverage varies by Part D plan. Keep reading to learn how much the medication might cost with coverage, and how to save if you pay cash.

Medicare Part D may cover Wegovy for individuals with cardiovascular disease (CVD) who also have obesity or overweight. For Medicare to cover Wegovy as a cardiovascular medication, you must plan to use the medication in combination with diet and exercise and have a documented diagnosis of both CVD and either obesity or overweight. Prior authorization may be required.

Covered conditions for cardiovascular disease include:

• A history of heart attack

• A history of stroke

• Peripheral artery disease

Over 30% of Americans on Medicare have cardiovascular disease, and about 41% have obesity. Nearly four million Medicare beneficiaries have both, and may qualify for treatment with Wegovy, according to a recent analysis by KFF.

Wegovy may only be covered for heart disease 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 durable medical equipment (such as diabetic 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. 

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Does Medicare cover Wegovy for weight loss? 

Yes, Medicare currently covers Wegovy for weight loss. While Medicare historically has not covered weight loss medications, both the Wegovy pill and injection are covered for $50 per month under a temporary GLP-1 Bridge program for Medicare Part D. Other covered GLP-1s include Foundayo (orforglipron) and Zepbound (tirzepatide) KwikPens. The program is scheduled to end December 31, 2027.

For the Medicare Part D GLP-1 Bridge program to cover Wegovy for weight loss, you must plan to use the medication with diet and exercise and meet one of the following three clinical criteria:

• You have a body mass index (BMI) of 35 or higher.

• You have a BMI of 30 or higher and heart failure, high blood pressure, or chronic kidney disease.

• You have a BMI of 27 or higher and prediabetes, history of heart attack or stroke, or peripheral artery disease.

The cost of Wegovy, when covered by Medicare Part D for a non-weight-management indication, depends on the details of your plan, specifically the deductible, coinsurance, and copay. The upper limit for Medicare deductibles is $615 in 2026, and $700 in 2027. Some plans have no deductible at all. If your plan has a deductible, you will pay your plan's copay for Wegovy until you reach your deductible.

After you reach your deductible, you will pay 25% of the cost of Wegovy as coinsurance. If your plan charges coinsurance for Wegovy, you may pay around $337 per month for the medication — 25% of the medication's $1,349.02 list price. However,Wegovy may cost less in 2027 because it is among the brand drugs selected for Medicare price negotiation.  The best way to know how much you will pay for Wegovy is to review your plan's prescription drug coverage using Medicare's plan comparison tool.

Medicare plans limit the total out-of-pocket costs Medicare enrollees pay for prescription drugs. In 2026, this is capped at $2,100, and in 2027, it is capped at $2,400. Once you hit the max, you will pay $0 for covered Medicare Part D medications for the rest of the year.

If you get Wegovy for weight loss through the GLP-1 Bridge, it is processed outside of your Part D prescription drug coverage. It has a $50 copay every month, regardless of whether you have met your deductible or total out-of-pocket costs.

In clinical trials, people taking Wegovy lost an average of 9.6%–18.8% of their body weight in about a year and a half. As many as 88% of people on the highest dose (7.2 mg weekly) lost at least 5% of their body weight. Substantial weight loss on its own may lower the risk of experiencing a heart attack or other major cardiovascular event. Living with obesity raises the 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 suggest that Wegovy lowers the risk of heart attack, stroke, or cardiovascular death by 20%. Semaglutide, the active ingredient in Wegovy, was shown to lower cardiovascular risk by up to 26% in a 2016 trial in people with type 2 diabetes — though that trial used a lower semaglutide dose in a different formulation, predating Wegovy's own approval. Other research suggests Wegovy may reduce the risk of stroke by 39%.

Research suggests that taking Wegovy also offers other benefits related to heart health, including improved blood pressure and cholesterol. 

While Medicare may cover Wegovy for heart disease or weight loss, there are situations where coverage is denied. At the time of writing, there is no approved generic form of Wegovy, and brand-name Wegovy has a cash price of more than $1,300 per month without coverage.

Still, there are ways to save on Wegovy if Medicare does not cover it.

Pay in cash 

Self-pay — paying in cash — can help you save on Wegovy without insurance. Ro offers Wegovy at a fraction of its list price for those who pay cash. On Ro, you can get Wegovy for these cash-pay prices (if prescribed):

• Wegovy injection: $199–$399 per month, depending on dose*

• Wegovy pill: $149–$299 per month, depending on dose*

Price-shop at different pharmacies

You can also 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 per month. 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 is a good idea to check.

You can also consider getting Wegovy online or through a mail-order pharmacy. Some pharmacies may 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 Wegovy coupon cards that you can use at specific pharmacies. These can bring down the price of Wegovy significantly. 

All you need to do is visit the website, select your dosage of Wegovy and your preferred pharmacy, and download or print the discount card.

Consider Wegovy alternatives 

You can also ask your healthcare provider about other alternatives to Wegovy, which may be covered by Medicare for heart disease. 

Ozempic (semaglutide), for example, is available as a daily pill and once-weekly GLP-1 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 cardiovascular disease risks in certain people with type 2 diabetes. Ozempic is also FDA-approved to lower the risk of worsening kidney problems in people with type 2 diabetes and chronic kidney disease.

Mounjaro (tirzepatide) is another once-weekly injection. Like Ozempic, it is approved to help manage blood sugar levels and lower cardiovascular risk in people with type 2 diabetes.

Another option is liraglutide, a daily GLP-1 injection that’s available as a generic version of Saxenda and Victoza. Like Ozempic and Mounjaro, it is FDA-approved for cardiovascular risk reduction and blood sugar control in people with diabetes. However, unlike Ozempic and Mounjaro, it involves a daily injection.

Ozempic costs $997.58 per month, which is about $351 less than the list price of Wegovy. Brand-name Victoza can be even more affordable, with average costs ranging from $543.51–$815.27. Mounjaro has the highest list price of the three, at $1,112.16 without insurance or pharmacy discounts.

Start your journey

Medicare Part D may cover Wegovy for people with cardiovascular disease (CVD) who also have obesity or overweight.The cost of Wegovy with Medicare can vary, depending on your plan’s deductible, copays, and coinsurance details. Here’s what you need to know:

• Whether Medicare covers Wegovy is diagnosis-based. To get coverage for cardiovascular risk reduction, you must have obesity or overweight and established CVD (i.e. a history of heart attack or stroke, peripheral artery disease).

• Out-of-pocket costs have limits. Starting in 2026, total annual prescription drug spending for Medicare enrollees is capped at $2,100. In 2027, the cap increases to $2,400.

• You still have savings options. If you do not qualify for coverage, consider Ro's cash-pay pricing, pharmacy discount cards, or alternative medications such as Ozempic, Mounjaro, or generic liraglutide.

* Prices may reflect limited-time offers and are subject to change; see more here.