Does Medicare Cover Wegovy Cost?

Wegovy has emerged as a groundbreaking medication for weight management, offering hope to millions seeking to improve their health. With its ability to reduce appetite and support significant weight loss, it’s no surprise that people are eager to explore this option.

However, for those relying on Medicare, a pressing question arises: Does Medicare cover Wegovy cost? The answer isn’t straightforward, but it’s one worth unraveling as it impacts affordability and access for millions of beneficiaries.

Navigating Medicare coverage can feel like a maze, especially when it comes to newer medications like Wegovy. As of February 28, 2025, the landscape has shifted slightly, offering some clarity but also leaving gaps.

This article will break down the details—when Medicare covers Wegovy, what costs you might face, and how to make sense of it all. Whether you’re a senior, a caregiver, or simply planning ahead, understanding this could save you time, money, and frustration.

What Is Wegovy and Why Does It Matter?

Wegovy, with its active ingredient semaglutide, belongs to a class of drugs called GLP-1 receptor agonists. Originally developed to treat type 2 diabetes (under the brand name Ozempic), it gained FDA approval in 2021 for chronic weight management.

It’s prescribed for adults with obesity (BMI of 30 or higher) or those overweight (BMI of 27 or higher) with weight-related conditions like hypertension or diabetes. Recently, it’s also been approved for reducing cardiovascular risks, a game-changer for many.

The drug works by mimicking a hormone that regulates appetite, helping you feel full longer and eat less. Studies show it can lead to a 15% reduction in body weight over time, making it a powerful ally when paired with diet and exercise.

For Medicare beneficiaries—many of whom face obesity-related health challenges—Wegovy could be transformative. But the cost, often exceeding $1,300 per month without coverage, puts it out of reach for many unless insurance steps in.

Medicare Basics: What’s Covered and What’s Not?

Medicare is a federal health insurance program primarily for people aged 65 and older, though it also covers some younger individuals with disabilities. It’s divided into parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Wegovy, being a self-administered injectable medication, falls under Part D or Medicare Advantage plans with drug coverage—not Part B, which handles doctor-administered drugs.

Historically, Medicare has been restricted by law from covering weight-loss drugs. The Medicare Modernization Act of 2003 classified these as “cosmetic” rather than medically necessary, excluding them from basic coverage. This means that for years, beneficiaries seeking drugs like Wegovy for obesity alone had to pay out of pocket. However, recent developments have cracked open the door to partial coverage under specific conditions.

Does Medicare Cover Wegovy Cost? The Current Landscape

So, does Medicare cover Wegovy cost? As of 2025, the answer is: sometimes. In March 2024, the FDA expanded Wegovy’s approval to include reducing the risk of heart attacks, strokes, and cardiovascular death in adults with cardiovascular disease and either obesity or overweight.

This shift prompted the Centers for Medicare & Medicaid Services (CMS) to adjust its policy. Now, Medicare Part D plans can cover Wegovy—but only when prescribed for this cardiovascular benefit, not solely for weight loss.

This change opens coverage to an estimated 3.6 million Medicare beneficiaries who fit the criteria—about 7% of enrollees, according to the Kaiser Family Foundation (KFF). If you have a documented history of heart disease and meet the weight criteria, your Part D plan might cover it.

However, if your goal is weight loss without a cardiovascular diagnosis, Medicare won’t help with the cost. This distinction is critical and stems from the ongoing legal ban on covering anti-obesity drugs for obesity alone.

Who Qualifies for Coverage?

To qualify for Wegovy coverage under Medicare, you must meet specific medical criteria. You need a diagnosis of established cardiovascular disease—think prior heart attack, stroke, or peripheral artery disease—along with a BMI indicating obesity (30+) or overweight (27+) with related health issues. Your doctor must prescribe Wegovy specifically to reduce cardiovascular risk, not just to shed pounds.

About 1.9 million of those eligible already have diabetes and might have accessed GLP-1 drugs like Ozempic under Part D for that condition. The new indication broadens access, but it’s still narrow. If you’re unsure about your eligibility, a chat with your healthcare provider can clarify whether your medical history aligns with Medicare’s rules.

How Much Does Wegovy Cost With Medicare?

Even with coverage, the cost of Wegovy under Medicare varies. Without insurance, the list price hovers around $1,349 for a four-week supply, according to Novo Nordisk. Under Part D, your out-of-pocket costs depend on your plan’s specifics—deductibles, copayments, and whether Wegovy is classified as a specialty drug (often Tier 4 or 5), which carries higher coinsurance.

For 2025, beneficiaries might pay $325 to $430 per month—about 25% to 33% of the list price—until they hit the Part D out-of-pocket cap. Thanks to the Inflation Reduction Act, this cap is $2,000 in 2025, down from $3,300-$3,800 in 2024. Once you reach it, you pay nothing more for covered drugs that year. However, early in the year or with a high deductible, you could still face steep initial costs. Plans may also require prior authorization or step therapy (trying cheaper alternatives first), adding hurdles.

Comparing Costs: Medicare vs. Out-of-Pocket

If Medicare doesn’t cover Wegovy for your situation, paying cash is the alternative. At $1,349 monthly, that’s over $16,000 annually—a hefty burden. Manufacturer coupons from Novo Nordisk can drop it to as low as $500 per month for some, but these don’t apply if Medicare covers it. Check with your pharmacist or NovoCare (1-888-793-1218) for savings options if you’re footing the bill.

Medicare Advantage: A Different Angle

Medicare Advantage (Part C) plans, offered by private insurers, often include Part D drug coverage. Some may cover Wegovy under the same cardiovascular criteria as Original Medicare’s Part D, but it’s not guaranteed. Each plan sets its own formulary (list of covered drugs) and cost-sharing rules. A few plans might offer supplemental benefits for weight management, but don’t bank on it—most stick to the federal restriction on obesity-only coverage.

To find out, contact your plan administrator. Use Medicare’s Plan Finder tool (Medicare.gov/plan-compare) to compare options in your area. If your current Advantage plan doesn’t cover Wegovy and you qualify, switching during the annual enrollment period (October 15–December 7) might be worth considering.

Why Doesn’t Medicare Cover Wegovy for Weight Loss Alone?

The exclusion of weight-loss drugs traces back to 2003 legislation deeming them non-essential. At the time, obesity wasn’t widely recognized as a chronic disease. Today, despite mounting evidence linking obesity to heart disease, diabetes, and more, the law hasn’t budged. Advocacy groups like the Obesity Action Coalition are pushing bills like the Treat and Reduce Obesity Act to lift this ban, but progress is slow—experts predict 3-5 years before change.

This lag frustrates many. Obesity affects over 40% of U.S. adults, per the CDC, and Medicare beneficiaries are no exception—22% had an obesity diagnosis in 2022. Covering Wegovy could reduce long-term costs for related conditions, but the upfront price tag—potentially billions annually—worries policymakers. For now, coverage hinges on secondary benefits like heart health.

Proposed Changes: A Glimmer of Hope?

In November 2024, the Biden administration proposed a rule to let Medicare and Medicaid cover obesity drugs like Wegovy starting in 2026, regardless of other conditions.

This would be monumental, potentially aiding millions. CMS estimates it’d cost Part D $24.8 billion and Medicaid $14.8 billion over a decade. However, with a new administration looming, its fate is uncertain. Critics, including some in the incoming Trump team, argue diet and exercise should take priority over costly drugs.

If passed, it could lower costs dramatically—negotiated prices under the Inflation Reduction Act (effective 2027 for some drugs) might slash Wegovy’s price. For now, it’s a waiting game, but it’s a development to watch.

Alternatives If Medicare Won’t Cover Wegovy

If Medicare doesn’t cover Wegovy cost for you, explore other paths. Older weight-loss drugs like Xenical or phentermine might be cheaper but less effective. Ozempic, covered for diabetes, is sometimes prescribed off-label for weight loss—check your Part D formulary. Lifestyle programs like Medicare’s Diabetes Prevention Program offer free coaching for at-risk beneficiaries, though they lack medication.

The VA covers obesity management for veterans, including Wegovy, so if you’re eligible, contact your local VA. Private insurance or employer plans might also cover it—worth a check if you have dual coverage.

Tips to Navigate Coverage and Costs

Start by talking to your doctor—they can confirm eligibility and handle prior authorizations. Review your Part D or Advantage plan’s formulary annually; coverage can change.

If denied, appeal through Medicare—persistence pays off. For cash payers, Novo Nordisk’s savings card or patient assistance programs could ease the sting. Call 1-800-MEDICARE or visit Medicare.gov for personalized help.

Conclusion

Does Medicare cover Wegovy cost? Yes, but only for those with cardiovascular disease needing risk reduction—not for weight loss alone. This partial coverage reflects a tension between medical need and policy limits, leaving many to shoulder high costs or seek alternatives. The $2,000 out-of-pocket cap in 2025 offers relief once reached, but early expenses can still pinch.

Change may be on the horizon with proposed rules, yet for now, beneficiaries must navigate a patchwork system. Armed with knowledge, you can advocate for yourself—whether that’s securing coverage, finding savings, or exploring other options. Wegovy holds promise, and understanding Medicare’s stance is the first step to making it work for you.

FAQs

Does Medicare cover Wegovy for weight loss?

No, Medicare doesn’t cover Wegovy solely for weight loss due to a 2003 law excluding obesity drugs. Coverage applies only for cardiovascular risk reduction with a qualifying diagnosis.

What’s the cost of Wegovy with Medicare Part D?

If covered, you might pay $325-$430 monthly until hitting the $2,000 out-of-pocket cap in 2025, depending on your plan’s deductible and coinsurance.

Can Medicare Advantage cover Wegovy differently?

Yes, some Advantage plans with Part D might cover it for cardiovascular use, but it varies. Check your plan’s formulary.

What if I miss the coverage criteria?

You’ll pay full price—around $1,349 monthly—unless you qualify for manufacturer discounts or other assistance.

Are there cheaper alternatives Medicare covers?

Possibly. Ozempic (for diabetes) or older drugs like phentermine might be options—confirm with your plan.

Will Medicare ever cover Wegovy for obesity alone?

Maybe. A 2024 proposal aims for 2026 coverage, but it’s uncertain with political shifts. Stay tuned.