Many people struggling with obesity or overweight issues have turned to Wegovy as an effective treatment. This injectable medication, containing semaglutide, helps with significant weight loss when combined with diet and exercise. It has become one of the most talked-about options in recent years.
However, the high cost of Wegovy — often over $1,300 per month without insurance — makes coverage a major concern. Seniors and people with disabilities who rely on Medicare frequently ask the same question about this popular drug.
What Is Wegovy and How Does It Work?
Wegovy is an FDA-approved prescription medicine specifically designed for chronic weight management. It belongs to a class of drugs called GLP-1 receptor agonists. The active ingredient mimics a hormone that regulates appetite and food intake.
Patients inject Wegovy once a week using a pre-filled pen. Clinical studies show that most users lose 15% or more of their body weight over 68 weeks. Doctors usually prescribe it to adults with a BMI of 30 or higher, or 27 with weight-related conditions.
Why Is Medicare Coverage Important for Wegovy?
Medicare serves millions of Americans aged 65 and older, plus younger people with certain disabilities. For many of them, paying full price for brand-name drugs like Wegovy is simply not possible. Coverage can reduce the monthly cost to $0–$50 in some cases.
Without coverage, patients often stop treatment after a few months. This leads to weight regain and frustration. Understanding Medicare rules helps patients plan their treatment and budget properly.
Is Wegovy Covered by Medicare in 2025?
Yes, Wegovy can now be covered by Medicare Part D and Medicare Advantage plans — but only under specific conditions.
Starting in 2025, the Centers for Medicare & Medicaid Services (CMS) allows coverage of Wegovy and similar GLP-1 drugs when prescribed for FDA-approved indications beyond just diabetes. This includes chronic weight management in patients who also have established cardiovascular disease or high risk of heart events.
Pure obesity treatment without heart-related conditions is still generally not covered by original Medicare Part D plans in most cases.
Who Qualifies for Medicare Coverage of Wegovy in 2025?
To get Wegovy covered, patients usually need to meet all these requirements:
Have a Qualifying Medical Condition
You must have documented cardiovascular disease (prior heart attack, stroke, or peripheral artery disease) or be at very high risk. Some plans also accept severe heart failure or chronic kidney disease linked to obesity.
Meet BMI and Weight-Related Criteria
BMI of 30 or higher, or BMI of 27 with at least one weight-related condition such as hypertension or high cholesterol (in addition to the heart condition).
Get Prior Authorization
Almost every Part D plan requires prior authorization. Your doctor must submit medical records proving you meet the coverage rules.
Try Step Therapy First (Sometimes)
Certain plans require you to try older, cheaper weight-loss medications first before approving Wegovy.
Original Medicare vs Medicare Advantage vs Part D Plans
| Type of Plan | Covers Wegovy for Weight Loss? (2025) | Typical Patient Cost After Approval | Notes |
|---|---|---|---|
| Original Medicare (Part A & B) | No | Not applicable | Does not include prescription drug coverage |
| Medicare Part D (stand-alone) | Yes, only with heart disease/risk | $0–$50 per month (after deductible) | Requires prior authorization and specific diagnosis |
| Medicare Advantage (Part C) | Varies by plan | $0–$100 per month | Some plans are more generous; many follow same CMS rules |
| Medigap (supplemental) | No | Not applicable | Only helps with Part B services, not prescription drugs |
How Much Does Wegovy Cost With Medicare Coverage?
If your Part D or Advantage plan approves coverage, you will typically pay:
- The plan’s deductible (up to $590 in 2025 for most plans)
- 25% coinsurance in the initial coverage phase
- $0–$35 copay in the coverage gap for brand-name drugs (thanks to the Inflation Reduction Act)
- Very low or $0 copay in catastrophic coverage after you spend $8,000 out-of-pocket
Many patients end up paying less than $50 per month once approved.
How to Get Wegovy Covered by Your Medicare Plan
Step 1: Talk to Your Doctor
Schedule an appointment and bring your weight history, BMI, lab results, and any heart-related diagnoses. Ask your doctor if you meet the new CMS criteria.
Step 2: Check Your Specific Plan
Log into your Part D or Medicare Advantage account online. Search the plan’s formulary (drug list) for “Wegovy” or “semaglutide.” Look for tier level and prior authorization requirements.
Step 3: Submit Prior Authorization
Your doctor’s office will fill out the paperwork. Include proof of cardiovascular disease or high risk, BMI documentation, and past weight-loss attempts.
Step 4: Use Manufacturer Savings Card (If Needed)
Novo Nordisk offers a savings card that can lower cost to as little as $0–$25 per month for eligible Medicare patients in 2025, even during deductible phases.
Step 5: Appeal If Denied
If the first request is denied, you have the right to appeal. Most approvals happen at the appeal level when proper documentation is provided.
Alternatives If Wegovy Is Not Covered
Some patients do not meet the heart-disease requirement. In those cases, consider these options:
- Switch to compounded semaglutide (not covered by insurance, $200–$400/month)
- Try older medications like phentermine or Contrave (sometimes covered)
- Look into state Medicaid programs (rules vary widely)
- Explore patient assistance programs directly from Novo Nordisk
Recent Changes That Affect Coverage
The Inflation Reduction Act of 2022 and new 2025 CMS guidance opened the door for limited coverage. Before 2025, Medicare almost never paid for any anti-obesity medication. The change reflects growing recognition that treating obesity can prevent costly heart attacks and strokes.
Summary
In 2025, Wegovy can be covered by Medicare Part D and many Medicare Advantage plans, but only when prescribed to reduce cardiovascular risk in patients with established heart disease or very high risk. Pure weight-loss treatment without a heart condition is still generally excluded. Coverage requires prior authorization, proper diagnosis codes, and often an appeal. With the right medical history and paperwork, many eligible patients pay less than $50 per month.
FAQ
Is Wegovy covered by Medicare for weight loss alone?
No. In 2025, coverage is limited to patients who have cardiovascular disease or high heart risk in addition to obesity. Weight loss by itself does not qualify under most plans.
How do I know if my Medicare Advantage plan covers Wegovy?
Log into your plan’s online portal and search the formulary for Wegovy. You can also call the number on the back of your insurance card and ask about tier placement and prior authorization rules.
Can I use the Wegovy savings card with Medicare?
Yes. In 2025, Medicare Part D patients can use the Novo Nordisk savings card and pay as little as $0–$25 per month for up to 13 fills, even if you haven’t met the deductible yet.
What if my prior authorization is denied?
File an appeal within 60 days. Include additional medical records, a letter of medical necessity from your doctor, and any cardiovascular test results. Most approvals happen during the appeal process.
Is Ozempic covered the same way as Wegovy?
Ozempic is approved for diabetes, so it has been covered by Medicare Part D for years when used for type-2 diabetes. Using Ozempic off-label for weight loss follows the same limited 2025 rules as Wegovy.
Dr. Hamza is a medical content reviewer with over 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic conditions. His reviews are grounded in trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Hamza is intended for educational purposes and is not a substitute for professional medical advice.