Medicare can cover Wegovy, but it depends on why the drug is prescribed. For weight loss alone, the law keeps it out of the regular Part D benefit; for a heart-risk use, or under a temporary CMS program, there is a route in.
Without any coverage, the self-pay price is $349 a box, as the Wegovy cost guide sets out, and the tablet has its own ladder in the Wegovy pill cost guide. The three routes below are what change those figures for someone on Medicare.
| Why it is prescribed | Route | What decides it |
|---|---|---|
| Weight loss alone | Excluded from the Part D benefit | The statute's weight-loss exclusion |
| Weight loss, meeting the CMS criteria | Medicare GLP-1 Bridge, $50 a month | A prior authorization that attests the BMI and diagnosis criteria |
| Heart-risk reduction with established heart disease, or MASH | Your Part D plan | An FDA-labeled use other than weight loss, and the plan's formulary |
The weight-loss exclusion
The Part D statute defines a covered drug, then removes the drug classes that Medicaid may exclude[1]. First on that Medicaid list is “agents when used for anorexia, weight loss, or weight gain”[2].
The words “when used for” matter. The exclusion follows the use, not the molecule. CMS’s own table marks weight-loss agents as not covered under the basic Part D benefit[4], and it defines a medically accepted indication as an FDA-labeled use or one supported in the standard compendia[4].
The heart-risk route
On March 8, 2024, FDA approved a new Wegovy indication[3]. It reduces the risk of major cardiovascular events in adults with established cardiovascular disease and either obesity or overweight[3]. The indication rests on the SELECT trial[3].
That is a labeled use other than weight loss, so it can fall inside Part D. Whether your plan lists Wegovy, and what it asks your prescriber to document, is still the plan’s formulary decision, so ask the plan before the pharmacy.
The label also carries a liver indication, for noncirrhotic MASH with moderate to advanced fibrosis[6]. CMS says MASH, like type 2 diabetes and moderate to severe sleep apnea, is eligible for Part D coverage[5].
The Medicare GLP-1 Bridge
CMS is running a short-term demonstration for weight management itself. It gives eligible Part D enrollees access to certain GLP-1 drugs from July 1, 2026 through December 31, 2027[5]. Wegovy’s pen and tablet are both on its list[8].
CMS’s fact sheet lists three products in all: Foundayo (tablet); Wegovy (injection or tablet); Zepbound (KwikPen only)[8]. Foundayo is orforglipron, a daily tablet with its own price board; how the Zepbound side works is in does Medicare cover Zepbound.
The copay is $50 for a one-month supply, whatever your income[8]. The program runs outside the Part D benefit, so the Part D deductible does not apply and the copay does not count toward your out-of-pocket total[7][8]. There is no low-income subsidy on it[7].
Who qualifies
A prescriber must submit a prior authorization attesting to the criteria, measured when GLP-1 therapy began[5]. The enrollee must be at least 18 and meet one of three BMI tests[5]:
- a BMI of 35 or more;
- a BMI of 30 or more, with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or later kidney disease;
- a BMI of 27 or more, with prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.
The plan type matters too. Stand-alone drug plans and Medicare Advantage coordinated care plans with drug coverage qualify; private fee-for-service, cost plans and PACE do not, unless the person also has a stand-alone drug plan[5].
What Medicare enrollees cannot use
The maker’s copay card excludes anyone enrolled in Medicare, as its terms and the savings card guide explain. Paying the self-pay price is allowed, but the purchase may not be submitted to the plan or counted toward its out-of-pocket limit.
Compounded semaglutide is a different product with no Part D path of its own; the insurance guide covers how plans treat compounded drugs.
The question to bring to your prescriber
Ask which use the prescription is for. A heart-risk prescription goes to your Part D plan; a weight-management prescription that meets the criteria goes through the Bridge’s prior authorization, before the end of 2027. Whether a health savings account can pay the rest is in can you use an HSA for peptides.