Does Medicare Part D cover Wegovy?
Coverage, cost, and 2026 details for Wegovy (semaglutide) under Medicare Part D.
Quick answer: Yes, Wegovy is generally covered by Medicare Part D plans, typically on Not typically covered for weight loss alone. Coverage details, copays, and restrictions vary by plan, so compare plans available in your area to find the best coverage for your medications.
What is Wegovy?
Wegovy (semaglutide) is the same active ingredient as Ozempic but at a higher dose, FDA-approved specifically for chronic weight management. It's a once-weekly injection used along with diet and exercise in adults with obesity (BMI 30+) or overweight (BMI 27+) with weight-related conditions. Wegovy is also approved to reduce the risk of major cardiovascular events in adults with obesity and known heart disease.
Is Wegovy covered by Medicare Part D?
By federal law, Medicare Part D cannot cover medications when prescribed solely for weight loss. However, in March 2024, Medicare began covering Wegovy when prescribed to reduce the risk of cardiovascular events in adults with cardiovascular disease and obesity — a specific FDA-approved indication beyond weight loss alone. Coverage requires the prescriber to indicate this cardiovascular indication, and most plans require prior authorization.
Typical formulary tier
Wegovy is most often listed on Not typically covered for weight loss alone of Part D formularies. The exact tier — and the copay — depends on the specific plan you're enrolled in.
Weight loss vs. diabetes coverage
By federal law, Medicare Part D cannot cover medications when prescribed solely for weight loss. Wegovy is covered when prescribed for type 2 diabetes (or for cardiovascular benefit when applicable). Your prescriber must document the appropriate medical indication.
How much does Wegovy cost with Medicare Part D?
Without insurance, Wegovy costs around $1,400 per month at retail pharmacies. With Medicare Part D coverage, you typically pay Variable — many plans don't cover; if covered for cardiovascular indication, typically $40 to $400 per month before $2,100 cap.
Your actual cost depends on:
- Your plan's deductible — up to $615 in 2026
- The tier Wegovy is on in your plan's formulary
- Whether you've reached the $2,100 annual out-of-pocket cap
- Whether you qualify for Extra Help (Low-Income Subsidy)
- Whether you've enrolled in the Medicare Prescription Payment Plan (M3P), which spreads costs across the year
How to lower your Wegovy costs
1. Compare Part D plans for your specific drugs
The same drug can cost dramatically different amounts on different plans. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder to compare what Wegovy would cost across every plan available in your ZIP code.
2. Check if you qualify for Extra Help
If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help, which dramatically reduces what you pay for Wegovy and all your medications. Learn about Extra Help →
3. Use the Medicare Prescription Payment Plan (M3P)
M3P doesn't lower your total cost, but it spreads your annual out-of-pocket costs into monthly installments — which can help if Wegovy causes a big upfront pharmacy bill. Learn about M3P →
4. Look into Patient Assistance Programs
Novo Nordisk may offer a Patient Assistance Program for people with limited income who don't qualify for Extra Help. These programs can provide free or deeply discounted medication directly from the manufacturer. Learn more about manufacturer programs →
5. Ask about alternatives
Talk to your doctor about whether a different medication — including a generic version or a similar drug in the same class — would work for you.
Alternatives to Wegovy
Other medications used for weight management include:
- Diet, exercise, and lifestyle changes
- Bariatric surgery (covered by Medicare in some cases)
- Other weight-management approaches discussed with your doctor
Always discuss any medication change with your prescribing doctor.
Key facts about Wegovy on Medicare
- Medicare cannot cover Wegovy for weight loss alone
- Since March 2024, Medicare may cover Wegovy for adults with obesity and cardiovascular disease
- Coverage requires prior authorization confirming the cardiovascular indication
Frequently asked questions about Wegovy on Medicare
Does Medicare cover Wegovy?
Yes, Wegovy is generally covered by Medicare Part D plans, most often on Not typically covered for weight loss alone. Coverage and costs vary between plans, so compare plans available in your area. Some plans require prior authorization.
How much does Wegovy cost on Medicare Part D?
Costs typically range from Variable — many plans don't cover; if covered for cardiovascular indication, typically $40 to $400 per month before $2,100 cap. Your actual cost depends on your plan's deductible, the tier Wegovy is on, and whether you've reached the $2,100 annual out-of-pocket cap.
Is there a generic version of Wegovy?
No, there is no generic version of Wegovy currently available. Patent expirations and FDA approvals will eventually allow generics, but the timing varies. Talk to your doctor about other medications in the same class that may have generic options.
What if my Part D plan doesn't cover this drug?
You have several options: (1) Switch to a different Part D plan during Annual Enrollment that covers Wegovy, (2) Request a formulary exception from your current plan with your prescriber's support, (3) Ask your doctor about a covered alternative medication, or (4) Look into the manufacturer's Patient Assistance Program if you have limited income.
Compare your Part D options
Coverage and costs for this drug vary significantly between plans. Compare your options:
You can also visit Medicare.gov or call 1-800-MEDICARE