THE SHORT ANSWER
Does Medicare Cover Wegovy?
Does Medicare cover Wegovy? Yes, with conditions—as of July 1, 2026, Medicare can cover Wegovy for weight loss through the new Medicare GLP-1 Bridge at a flat $50 per monthly fill, covering all Wegovy formulations (injection and oral tablets). The Bridge is a temporary CMS program that runs outside the Part D benefit: you need eligible Part D coverage, you must meet CMS's eligibility criteria, and your prescriber must get prior authorization. Separately, Wegovy may be covered under Part D, subject to your plan's formulary, prior authorization and exceptions process, when it's prescribed to reduce cardiovascular risk in adults with established cardiovascular disease and either obesity or overweight—a separate FDA-approved indication (injection: March 8, 2024 (Wegovy injection); tablets: December 22, 2025 (Wegovy tablets)) that isn't excluded by the weight-loss statute.
Yes—Medicare Can Now Cover Wegovy (Two Pathways)
As of July 1, 2026, Medicare can cover Wegovy for weight loss through the new Medicare GLP-1 Bridge—a flat $50 per monthly fill, covering all Wegovy formulations (injection and oral tablets), if you have eligible Part D coverage, meet CMS's criteria and your prescriber gets prior authorization.[29] Separately, Wegovy may be covered under Part D, subject to the plan's formulary, prior authorization and exceptions process, when it's prescribed for cardiovascular risk reduction in adults with established cardiovascular disease and either obesity or overweight.[26]
Which pathway applies to you depends on why Wegovy is prescribed and which Medicare plan you have:
- For weight loss: The Medicare GLP-1 Bridge now covers all Wegovy forms at $50 per monthly fill for eligible Part D beneficiaries (BMI-based criteria + prior authorization; Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026)
- For cardiovascular risk reduction: May be covered under Part D via the CV indication (SELECT trial), subject to the plan's formulary, prior authorization and exceptions process—this routes through your Part D plan, not the Bridge[26]
- Medicare Advantage: Coverage for the CV indication varies by plan
Bottom line: Eligible Medicare beneficiaries now have a weight-loss pathway for Wegovy—the $50 Bridge (all forms, with conditions)—plus possible Part D coverage for the cardiovascular indication. The right path depends on your indication and your plan. Of the Bridge drugs, only Wegovy has an FDA-approved cardiovascular indication.
For a complete overview of getting Wegovy covered regardless of insurance type, see our full coverage guide.
THE WEIGHT-LOSS PATHWAY (LIVE SINCE JULY 1, 2026)
The $50 Medicare GLP-1 Bridge
The Medicare GLP-1 Bridge is a CMS demonstration that launched July 1, 2026 and runs through December 31, 2027. It runs outside the Part D benefit and is the now-live way for eligible Medicare Part D beneficiaries to get a weight-loss GLP-1—including Wegovy—for a flat copay, if they meet CMS's criteria and their prescriber gets prior authorization.[29]
What the Bridge Covers for Wegovy
- $50 flat monthly copay—the same regardless of dose or your Part D benefit phase[29]
- All Wegovy formulations covered. Unlike Zepbound—where only the KwikPen is covered (single-dose pens and vials are excluded)—the Bridge covers every form of Wegovy: the injection pens and the oral tablets[31]
- Weight-loss indication. The Bridge covers Wegovy prescribed for weight reduction and maintenance (with ongoing lifestyle modification)
- Eligibility is BMI-based, with exclusions and prescriber prior authorization: Part D plans and pharmacies don’t opt in, and you don’t enroll separately; your prescriber must get prior authorization
What the $50 Doesn't Count Toward
The Bridge copay is collected at the pharmacy, but it does not apply to your Part D deductible or your annual out-of-pocket cap, and Extra Help / LIS doesn't reduce it—even beneficiaries who normally pay only a few dollars per prescription pay the full $50.[29]
This Is Coverage Support, Not an Appeal
The Bridge is a coverage pathway, not an appeal. You don't need a denial first—your prescriber submits a prior authorization confirming you meet the criteria. If that prior authorization is denied: No appeals process for a Bridge prior-authorization denial: your prescriber can resubmit with more information (Part D appeal rights for Part D coverage decisions still apply). (If you're separately seeking Wegovy for cardiovascular risk reduction through Part D and get denied, that's when an appeal comes into play—see below.)
Full Bridge Guide: Eligibility, Cost & How to Apply
For the complete BMI tiers and qualifying conditions, plan-type eligibility, the cost catches, and the step-by-step prior authorization process, see our dedicated Medicare GLP-1 Bridge guide.
Quick things to check for Wegovy: that you meet one of the Bridge's BMI tiers, that none of the exclusions apply (Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026), and that your plan type is eligible. Any covered Wegovy form (injection or oral tablet) works—there's no formulation restriction like Zepbound's. The Bridge guide walks through each step.
Bridge vs. the Permanent BALANCE Model
The Bridge is a temporary program (through Dec 31, 2027). The separate, permanent BALANCE Model that would have built weight-loss GLP-1 coverage into Part D is delayed, with no new start date—on April 21, 2026, CMS declined to implement it in Part D for 2027 and extended the Bridge instead.[28] Coverage after the Bridge ends is currently undetermined.
WHY THE BRIDGE EXISTS
Part D & the Weight-Loss Exclusion
The reason Wegovy's weight-loss coverage runs through the $50 Bridge—rather than your regular Part D plan—is a long-standing federal law. Unlike commercial insurance that can choose whether to cover weight loss medications, basic Medicare Part D coverage excludes drugs used for weight loss by statute (some enhanced plans could offer them as supplemental benefits). The Bridge is a separate, temporary CMS demonstration that runs outside the Part D benefit; outside the Bridge, the exclusion still applies.
The Statutory Exclusion
42 U.S.C. § 1395w-102(e)(2)(A) cross-references the Medicaid exclusion at 42 U.S.C. § 1396r-8(d)(2), which lists "agents when used for anorexia, weight loss, or weight gain" among the drugs left out of basic Part D coverage.[2]
This law was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and remains in effect today.
What This Means for You
| Indication | Part D Coverage | Reason |
|---|---|---|
| Chronic Weight Management | Not by your Part D plan; Bridge: $50 per monthly fill (with conditions) | Excluded from basic Part D coverage by 42 U.S.C. § 1395w-102; the separate Medicare GLP-1 Bridge (outside Part D) covers Wegovy for weight loss, with conditions |
| Cardiovascular Risk Reduction | May Be Covered (formulary, PA and exceptions process apply) | FDA-approved indication for adults with established cardiovascular disease and either obesity or overweight (SELECT trial; injection March 8, 2024 (Wegovy injection), tablets December 22, 2025 (Wegovy tablets)) |
| Type 2 Diabetes (Ozempic) | Check Plan | Same drug (semaglutide); different brand |
How the Weight-Loss Pathway Opened Up
🗓️ From Announcement to Live Program
On November 6, 2025, the Trump administration announced agreements with Eli Lilly and Novo Nordisk to expand Medicare coverage of GLP-1 medications (a class of weight loss and diabetes drugs including Wegovy, Ozempic, and Zepbound) for obesity.[3][21][22]
That coverage is now live. The Medicare GLP-1 Bridge launched July 1, 2026, giving eligible Part D beneficiaries who meet CMS's criteria and get prior authorization all forms of Wegovy for $50 per monthly fill.[29]
See the $50 GLP-1 Bridge section above for what's covered today, and the BALANCE Model note below for the separate permanent program, which is delayed with no new start date.
Who Is Eligible
How Eligibility Actually Works Under the Bridge
The live Bridge uses three BMI tiers: Age 18+ and BMI ≥35; or BMI ≥30 with HFpEF, uncontrolled high blood pressure or CKD stage 3a+; or BMI ≥27 with prediabetes, a prior heart attack or stroke, or symptomatic PAD. Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026. See the full Bridge guide for the exact tiers and conditions.[29]
What You'll Pay
| Scenario | Monthly Cost |
|---|---|
| What you pay (Bridge beneficiary copay) | $50 per monthly fill[29] |
Behind the scenes: participating manufacturers provide Bridge drugs at a net program price of $245 per monthly supply, and the pharmacy is paid the wholesale acquisition cost minus your $50 copay, plus a $3 dispensing fee ($5 in long-term care) and any applicable sales tax. Eligible beneficiaries pay only the $50 per monthly fill copay—not that amount. Note the $50 does not count toward your deductible or out-of-pocket cap, and Extra Help doesn't reduce it.
How We Got Here: The Timeline
| Date | What Happened |
|---|---|
| November 6, 2025 | White House announces Medicare GLP-1 coverage agreements with Lilly and Novo Nordisk[3] |
| December 23, 2025 | CMS announces the BALANCE Model as the planned permanent framework[28] |
| February 5, 2026 | TrumpRx.gov launched; TrumpRx lists the manufacturers’ own self-pay prices (not a separate, cheaper price)[21] |
| April 21, 2026 | CMS declines to implement BALANCE in Part D for 2027; extends the GLP-1 Bridge instead[28] |
| July 1, 2026 ✅ LIVE | Medicare GLP-1 Bridge launches—$50/month, all Wegovy formulations[29] |
| December 31, 2027 | Scheduled end of the Bridge; coverage afterward is undetermined[29] |
What About the Permanent BALANCE Model?
BALANCE Is Delayed, With No New Start Date
The BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) was the planned permanent framework to waive the Part D weight-loss exclusion in Part D.[30] On April 21, 2026, CMS declined to implement it in Part D for 2027 and extended the temporary GLP-1 Bridge through Dec 31, 2027 instead.[28] BALANCE in Part D: Delayed, with no new start date. The Bridge—not BALANCE—is the live weight-loss pathway today.
TrumpRx: Direct-Purchase Option (February 2026)
Can't Use the Bridge?
TrumpRx.gov launched on February 5, 2026. TrumpRx lists the manufacturers’ own self-pay prices (not a separate, cheaper price): for Wegovy, that means Novo Nordisk’s self-pay price, redeemed with a coupon at a retail pharmacy.[21]
- Price: $349/month ($399 for Wegovy HD 7.2 mg) for the injection (list price $1,349/month)
- Medicare beneficiaries: If you have government insurance, ask NovoCare whether you can use self-pay pricing
Your Pathways Today
If you're a Medicare beneficiary who wants Wegovy, here's where coverage stands now:
- Weight loss: The $50 GLP-1 Bridge (all Wegovy forms)—Part D plans and pharmacies don’t opt in, and you don’t enroll separately; your prescriber must get prior authorization
- CV-risk pathway: If you have established cardiovascular disease, Part D coverage may be available (see below)
- TrumpRx: Lists the same self-pay price as NovoCare ($349/month ($399 for Wegovy HD 7.2 mg))
- Self-pay: See our cost guide for other options
WEGOVY'S UNIQUE COVERAGE PATHWAY
The Cardiovascular Exception: Wegovy's Part D Carve-Out
Wegovy Has a Unique Advantage
On March 8, 2024 (Wegovy injection), the FDA expanded Wegovy injection's approval to include cardiovascular risk reduction in adults with established cardiovascular disease and either obesity or overweight.[26] The Wegovy tablets carry the same indication, which came with their approval on December 22, 2025 (Wegovy tablets). This makes Wegovy the only GLP-1 weight loss medication with this indication—Zepbound does not have it.
Since the Part D exclusion applies specifically to "weight loss" drugs, Medicare plans may cover Wegovy when prescribed for cardiovascular risk reduction—a legitimate medical indication not excluded by statute—subject to the plan's formulary, prior authorization and exceptions process.
This Pathway Routes Through Part D, Not the Bridge
The cardiovascular indication is Wegovy's Part D carve-out—the equivalent of Zepbound's obstructive sleep apnea (OSA) carve-out. Because reducing cardiovascular risk is a coverable medical use under basic Part D, a CV-risk prescription is handled by your regular Part D plan (through its formulary and, if needed, its appeals process)—not through the $50 GLP-1 Bridge, which covers the weight-loss indication. In short: weight loss → the $50 Bridge; cardiovascular risk reduction → Part D.
Important: Wegovy Is NOT Approved for OSA
Unlike Zepbound (tirzepatide), which was FDA-approved for obstructive sleep apnea (OSA) in December 2024, Wegovy is not approved for OSA. Wegovy's carve-out is cardiovascular, not sleep apnea. If you have sleep apnea and want coverage through that pathway, ask your doctor about Zepbound instead. See our Zepbound Medicare guide.
SELECT Trial: The Evidence for CV Coverage
The SELECT trial (published in NEJM, November 2023) demonstrated that Wegovy reduces cardiovascular events:[27]
- 20% reduction in major adverse cardiovascular events (MACE)
- Includes heart attacks, strokes, and cardiovascular death
- 17,604 participants followed for ~3.3 years
- All participants had established cardiovascular disease plus obesity/overweight
Typical Plan Coverage Criteria for CV Indication
Criteria vary by plan (ask for yours in writing). Medicare plans that cover Wegovy for cardiovascular risk reduction may require:
Clinical Criteria
- Established cardiovascular disease (prior heart attack, stroke, or peripheral artery disease)
- BMI (body mass index) ≥ 27 kg/m²
- Concurrent lifestyle modifications (diet and exercise)
Required Documentation
- Cardiology records documenting established CVD
- Current BMI (height and weight within last 30 days)
- Letter of Medical Necessity from cardiologist or primary care provider
- Documentation of lifestyle modification attempts
ICD-10 Codes for CV vs. Obesity Billing
ICD-10 codes (standardized medical billing codes used by healthcare providers) determine how your prescription is classified for insurance purposes:
| Indication | ICD-10 Code | Medicare Coverage |
|---|---|---|
| Atherosclerotic Heart Disease | I25.10 | May be covered (CV indication) |
| History of Heart Attack | I25.2 | May be covered (CV indication) |
| History of Stroke | Z86.73 | May be covered (CV indication) |
| Obesity, Class I-III | E66.811-813 | Not by your Part D plan (weight-loss exclusion); the Bridge may cover it |
Billing for CV Indication
When prescribing Wegovy for cardiovascular risk reduction, the primary diagnosis code should reflect the cardiovascular condition (e.g., I25.10 for coronary artery disease). BMI codes (Z68.3x-Z68.4x) can be added as secondary diagnoses but should not be the primary reason for prescribing.
Note: The E66.811/812/813 obesity class codes are new as of October 1, 2024. Some systems may still use the older E66.01/E66.09 codes.[15]
Do You Qualify for the CV Pathway?
You may qualify if you have:
- History of heart attack (myocardial infarction)
- History of stroke
- Coronary artery disease (CAD) with stents or bypass surgery
- Peripheral artery disease (PAD)
- Plus: BMI ≥ 27 kg/m²
If you have these conditions, ask your cardiologist about prescribing Wegovy for cardiovascular risk reduction—this may qualify for Medicare coverage.
Your GLP-1 coverage,
denied approved
If Medicare denies Wegovy for CV risk reduction, Honest Care can help you build a strong appeal with evidence from the SELECT trial.
Denied by Medicare?
Get Help NowCOVERAGE VARIES BY PLAN
Medicare Advantage Wegovy Coverage
The basic Part D coverage in Medicare Advantage (Part C) plans with prescription drug coverage (MA-PD) excludes drugs used for weight loss, but MA-PD members can use the GLP-1 Bridge (outside the plan's Part D benefit, with conditions); coverage for the CV indication varies significantly by plan.
| Plan Type | Weight Loss Coverage | CV Indication | Notes |
|---|---|---|---|
| Original Medicare + Part D | Not by the plan; Bridge: $50 per monthly fill (with conditions) | Check Plan | Standalone Part D plans may include CV indication |
| Medicare Advantage (HMO) | Not by the plan; Bridge: $50 per monthly fill (with conditions) | Check Plan | Coverage varies; ask whether prior auth is required |
| Medicare Advantage (PPO) | Not by the plan; Bridge: $50 per monthly fill (with conditions) | Check Plan | May have broader formulary; still requires PA |
| Medicare Supplement (Medigap) | Does not cover prescription drugs—you need separate Part D | ||
What to Know About MA Plans
- Formularies vary: Not all MA plans have added Wegovy for CV risk reduction to their formulary (the plan's list of covered drugs)
- Expect prior authorization: Plans can require prior authorization (pre-approval from your insurer before filling the prescription) with cardiology documentation; ask your plan for its criteria
- Cost sharing varies: Plans have different tiers, copays (fixed dollar amounts), and coinsurance (percentage of drug cost)
- Out-of-pocket limits: An MA plan's yearly out-of-pocket maximum covers medical (Part A and B) services, not prescription drugs. Drug costs count toward the separate Part D cap ($2,100 in 2026 ($2,400 in 2027)).
Open Enrollment Consideration
If your current Medicare plan doesn't cover Wegovy for CV risk reduction, you may be able to switch to a plan that does during the Annual Enrollment Period (October 15 - December 7) or Medicare Advantage Open Enrollment (January 1 - March 31). Learn more at Medicare.gov enrollment periods.
WHAT YOU'LL PAY
Wegovy Cost & Alternatives for Medicare Beneficiaries
Savings Card Not Available for Medicare
Medicare beneficiaries cannot use the Wegovy Savings Card. Federal law prohibits manufacturer copay assistance for government insurance programs including Medicare, Medicaid, TRICARE, and VA benefits.[17]
The savings offer (as little as $25 a month for commercially insured patients whose plan covers Wegovy) is not an option if you have any Medicare coverage.
If Wegovy Is Covered for CV Risk Reduction
If your plan covers Wegovy for cardiovascular risk reduction through Part D, here's what to expect for costs in 2026:
- 2026 Part D Out-of-Pocket Cap: Medicare Part D has a $2,100 annual out-of-pocket maximum for 2026 (up from $2,000 in 2025). Once you reach this limit, your plan covers 100% of remaining drug costs for the year.[18]
- 2026 Part D Deductible: Maximum deductible is $615 for 2026 (up from $590 in 2025).[32]
- Tier Placement: Varies by plan. Ask your plan which tier Wegovy is on and whether you pay a copay or coinsurance
- Before OOP Cap: Your monthly cost depends on your deductible, tier and coinsurance
- After OOP Cap: $0 for the rest of the calendar year
Note: These Part D cost figures apply to the cardiovascular indication billed through your Part D plan. The $50 GLP-1 Bridge (weight-loss pathway) works differently—a flat $50/month that does not count toward your deductible or out-of-pocket cap.
Extra Help (Low Income Subsidy)
If you have limited income and resources, you may qualify for Extra Help, which significantly reduces Part D costs:
| 2026 Limits | Individual | Married Couple |
|---|---|---|
| Income Limit | up to 150% of the federal poverty level | up to 150% of the federal poverty level |
| Resource Limit | $18,090 | $36,100 |
With Extra Help, copays are at most $5.10 for generics and $12.65 for brand-name drugs (2026). Extra Help does not lower the $50 Bridge copay. Apply at ssa.gov/medicare/part-d-extra-help.[19]
Ozempic Alternative for Type 2 Diabetes
Same Drug, Different Brand
If you have Type 2 Diabetes: Ozempic (also semaglutide, same active ingredient as Wegovy) may be covered under Medicare Part D for T2D, subject to your plan's formulary, prior authorization and exceptions process. Ask your doctor if Ozempic is appropriate for your diabetes management. (People with type 2 diabetes can't use the Bridge.)[20]
NovoCare Patient Assistance
Novo Nordisk's patient assistance program (NovoCare) provides free medications to eligible patients, including some Medicare Part D beneficiaries, based on income. Wegovy is not on Novo Nordisk’s Patient Assistance Program list.
- Income threshold: Up to 400% of Federal Poverty Level
- Exclusions: Cannot have Medicaid, full LIS (Extra Help), or VA benefits
- Important: Check the program’s current product list directly (1-866-310-7549)—the list changes periodically
Note: Since Wegovy isn't on the patient assistance list, NovoCare offers cash-pay pricing at $349/month ($399 for Wegovy HD 7.2 mg)—no insurance needed (If you have government insurance, ask NovoCare whether you can use self-pay pricing). New self-pay patients may qualify for $199/month for the first two fills (0.25 mg and 0.5 mg), through December 31, 2026. See our complete cost guide for all options including the new Wegovy pill ($149/month starting dose).
STEP-BY-STEP GUIDE
How to Check Your MA Plan's Formulary
Here's how to determine if your specific Medicare plan covers Wegovy for the CV indication:
Visit Medicare.gov Plan Finder
Go to Medicare.gov Plan Compare and enter your ZIP code. You can search for plans or look up your current plan.
Add Wegovy to Your Drug List
In the drug search, enter "Wegovy" or "semaglutide." The tool will show if and how the drug is covered on different plans.
Check for Coverage Notes
Look for notes about "covered indications" or "prior authorization required." Plans that cover Wegovy may specify it's for cardiovascular risk reduction, not weight loss.
Contact Your Plan Directly
Formularies can change, and the Plan Finder may not reflect the most current coverage. Call your plan's member services to confirm.
Call Script for Medicare Plan
"Hi, I'm calling to check coverage for a prescription medication. My Medicare ID is [NUMBER]. I need to know:
- Is Wegovy (semaglutide) covered on my plan's formulary for cardiovascular risk reduction?
- What tier is it on?
- What documentation is required for prior authorization?
- What would my out-of-pocket cost be?
- Can you send me the coverage criteria in writing?"
Pro tip: Request coverage criteria in writing and keep records of all calls, including the date, time, and representative's name.
APPEAL PROCESS
What to Do If Medicare Denies Wegovy
Bridge Denials Can't Be Appealed
The appeal steps below are for decisions by your Part D plan (for example, Wegovy for cardiovascular risk reduction). If a Bridge prior authorization for weight loss is denied: No appeals process for a Bridge prior-authorization denial: your prescriber can resubmit with more information (Part D appeal rights for Part D coverage decisions still apply).
Medicare Appeals Have High Success Rates
Over 80% of Medicare Advantage prior authorization appeals succeed—yet only about 11% of patients ever appeal, according to KFF analysis of CMS data.[6] If you're denied, don't give up.
Medicare Appeal Timeline
| Appeal Level | Filing Deadline | Decision Timeline | Notes |
|---|---|---|---|
| 1. Redetermination | Within 65 days from the date on the denial notice | 7 days (72 hrs if expedited) | Reviewed by plan, not original reviewer |
| 2. Reconsideration | Within 60 days after you receive the redetermination decision | 7 days (72 hrs if expedited) | Independent review by the IRE (Independent Review Entity) |
| 3. ALJ Hearing (Administrative Law Judge) | 60 days from reconsideration | 90 days | Requires $200+ amount in controversy (2026)[7] |
| 4. Medicare Appeals Council | 60 days from ALJ | 90 days | Reviews ALJ decision |
| 5. Federal District Court | 60 days from Council | Varies | Requires $1,960+ amount in controversy (2026)[7] |
How to Appeal a Medicare Denial
Get the Denial in Writing
Request a Coverage Determination Notice with the specific reason for denial. Common reasons include:
- "Not medically necessary"
- "Does not meet plan criteria"
- "Documentation insufficient"
- "Drug not on formulary for this indication"
Gather Supporting Documentation
Work with your doctor to compile:
- Cardiology records documenting established CVD (heart attack, stroke, PAD)
- Documentation showing BMI ≥ 27 kg/m²
- Lifestyle modification history
- Letter of Medical Necessity explaining cardiovascular benefit
File Redetermination Request
Submit your appeal to your Medicare plan within 65 days from the date on the denial notice. Include all supporting documentation and a cover letter addressing the specific denial reason.
Escalate If Necessary
If redetermination is denied, request Reconsideration by an independent Independent Review Entity (IRE). This is an entirely new review not influenced by the plan.
For detailed appeal strategies, see our complete Wegovy appeals guide.
MEDICARE WEGOVY COVERAGE
Frequently Asked Questions
Your regular Part D plan does not—by federal law (42 U.S.C. § 1395w-102), basic Part D coverage excludes drugs used for weight loss (some enhanced plans could offer them as supplemental benefits). But Medicare can still cover it, with conditions: the separate $50 Medicare GLP-1 Bridge (live since July 1, 2026) covers all Wegovy formulations—injection and oral tablets—for weight loss outside the Part D benefit, if you have eligible Part D coverage, meet CMS's criteria and your prescriber gets prior authorization. Wegovy may also be covered under Part D for cardiovascular risk reduction (subject to the plan's formulary, prior authorization and exceptions process), a separate FDA-approved indication for adults with established cardiovascular disease and either obesity or overweight (injection: March 8, 2024 (Wegovy injection); tablets: December 22, 2025 (Wegovy tablets)).
Potentially, yes. On March 8, 2024 (Wegovy injection), the FDA approved Wegovy injection for reducing the risk of cardiovascular death, heart attack, and stroke in adults with established cardiovascular disease and either obesity or overweight; the tablets got the same indication with their approval (December 22, 2025 (Wegovy tablets)). Since this is not a "weight loss" indication, it's not excluded by the Part D statute. Coverage depends on your plan's formulary, prior authorization and exceptions process. Expect prior authorization with cardiology documentation.
Criteria vary by plan (ask for yours in writing), but plans may ask for: Established cardiovascular disease (prior heart attack, stroke, or peripheral artery disease), BMI ≥ 27 kg/m², and documentation of ongoing lifestyle modifications. The prescription should list a cardiovascular ICD-10 code (e.g., I25.10 for coronary artery disease) as the primary diagnosis—not an obesity code.
Yes—as of July 1, 2026. The Medicare GLP-1 Bridge is now live and covers all Wegovy formulations (injection and oral tablets) for weight loss at a flat $50 per monthly fill for eligible Part D beneficiaries. It runs outside the Part D benefit.
Eligibility uses three BMI tiers (Age 18+ and BMI ≥35; or BMI ≥30 with HFpEF, uncontrolled high blood pressure or CKD stage 3a+; or BMI ≥27 with prediabetes, a prior heart attack or stroke, or symptomatic PAD). Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026. Part D plans and pharmacies don’t opt in, and you don’t enroll separately; your prescriber must get prior authorization.
One catch: the $50 doesn't count toward your deductible or out-of-pocket cap, and Extra Help doesn't reduce it. The Bridge runs July 1, 2026 – December 31, 2027. See our full Medicare GLP-1 Bridge guide for eligibility and how to apply.
You have five levels of Medicare appeals. Start with a Redetermination within 65 days from the date on the denial notice—the plan must respond within 7 days (72 hours if expedited). If denied again, request Reconsideration by an Independent Review Entity (IRE) within 60 days after you receive the redetermination decision. Don't give up after the first denial. Include cardiology records documenting established CVD, current BMI, lifestyle modification history, and a Letter of Medical Necessity citing the SELECT trial results.
The basic Part D coverage in Medicare Advantage drug plans excludes drugs used for weight loss, but members of MA plans with drug coverage (MA-PD) can use the Medicare GLP-1 Bridge for weight loss. However, coverage for the CV indication varies by plan—some MA plans have added Wegovy for cardiovascular risk reduction to their formularies while others have not. Check your specific plan's formulary using the Medicare.gov Plan Finder or call your plan directly, and ask whether prior authorization is required.
You may still have coverage. The Medicare GLP-1 Bridge (live since July 1, 2026) covers all Wegovy formulations for weight loss at $50 per monthly fill for eligible Part D beneficiaries—no CV diagnosis required, just the BMI-based eligibility criteria and prescriber prior authorization (Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026). See our Medicare GLP-1 Bridge guide.
If you don't qualify for the Bridge, other options include: self-pay ($349/month ($399 for Wegovy HD 7.2 mg) via NovoCare), TrumpRx (lists the same self-pay price), or Ozempic if you have Type 2 diabetes (same active ingredient; it may be covered under Part D for diabetes, subject to the plan's formulary, prior authorization and exceptions process). See our Wegovy cost guide for money-saving strategies. If you have government insurance, ask NovoCare whether you can use self-pay pricing.
YOUR PATH FORWARD
What's Next
Wegovy Coverage: Other Insurance Options
Coverage varies significantly by program type. See our guides:
- Medicaid — 13 states (as of January 2026) covered GLP-1s for obesity (state-dependent)
- TRICARE — Prior authorization: BMI ≥30, or ≥27 with a weight-related condition, after a lifestyle program and trials of other weight-loss drugs
- Humana — Medicare Advantage: weight loss through the Bridge; CV-risk coverage depends on the plan
- UnitedHealthcare — Medicare Advantage: weight loss through the Bridge; CV-risk coverage depends on the plan
- Aetna — Commercial coverage depends on your plan
Other GLP-1 Medications on Medicare
Medicare coverage varies by medication. Compare your options:
Your GLP-1 coverage,
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Get startedReferences
- Medical News Today. (2025). "Medicare and Wegovy: Coverage for weight loss." medicalnewstoday.com
- Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 42 U.S.C. § 1395w-102(e)(2)(A). law.cornell.edu
- White House. (November 6, 2025). "Fact Sheet: President Donald J. Trump Announces Major Developments in Bringing Most Favored Nation Pricing to American Patients." whitehouse.gov
- FDA. (December 20, 2024). "FDA Approves First Medication for Obstructive Sleep Apnea." fda.gov
- Medicare Interactive / NCOA. (2025). "Maximum out-of-pocket limit." 2025 Medicare Advantage MOOP: $9,350 in-network. medicareinteractive.org; ncoa.org
- Kaiser Family Foundation (KFF). (2024). "Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023." Analysis of CMS data: 83.2% of appeals partially or fully overturned in 2022; only 11% of denials appealed. kff.org; See also: AMA commentary at ama-assn.org
- CMS. (2025). "Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2026." Federal Register, December 4, 2025. 2026 thresholds: $200 for ALJ, $1,960 for Federal Court. federalregister.gov
- Wellcare. (2025). "Does Medicare Cover Weight-Loss Drugs? Understanding GLP-1 Coverage." wellcare.com
- ASPE/HHS. (2024). "Medicare Coverage of Anti-Obesity Medications." aspe.hhs.gov
- Georgetown Medicare Policy Initiative. (April 2025). "Policy options to cover anti-obesity drugs." georgetown.edu
- Medicare.gov. (2025). "Filing an appeal." medicare.gov
- Congressional Research Service. (2024). "Medicare Coverage of GLP-1 Drugs." IF12758. congress.gov
- Hernandez I, et al. (2024). "Medicare Part D Coverage of Anti-obesity Medications: A Call for Policy Change." JAMA Internal Medicine. pubmed.ncbi.nlm.nih.gov
- JAMA. (January 2025). "FDA Approves Tirzepatide as First Drug for Obstructive Sleep Apnea." jamanetwork.com
- CDC. (2024). "New Adult Obesity ICD-10-CM Codes." Codes E66.811, E66.812, E66.813 effective October 1, 2024. cdc.gov
- Malhotra A, et al. (2024). "Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity." N Engl J Med. 2024;391:1193-1205. SURMOUNT-OSA trial (NCT05412004). nejm.org
- Novo Nordisk. (2025). "Wegovy Savings Card Terms and Conditions." Excludes Medicare, Medicaid, TRICARE, VA, and other government programs. www.wegovy.com
- CMS. (2026). "Announcement of Calendar Year (CY) 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies," Table V-2 (Part D deductible and out-of-pocket threshold, 2026 and 2027). cms.gov
- Social Security Administration. "Extra Help with Medicare Prescription Drug Costs" (how to apply). 2026 resource limits and copays: CMS, "CY 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS)," October 31, 2025. ssa.gov
- CRS. (2024). Medicare Coverage of GLP-1 Drugs. IF12758. "Medicare allows coverage through Part D plans for GLP-1 drugs that the FDA has approved for T2DM and CVD." congress.gov
- NCPA. (November 11, 2025). "About the Trump, Eli Lilly, Novo Nordisk deals on GLP-1 prices." ncpa.org
- Axios. (November 6, 2025). "Trump announces Medicare coverage of weight-loss drugs." axios.com
- AARP. (November 2025). "When Will the Cost of GLP-1 Weight Loss Drugs Go Down?" aarp.org
- STAT News. (November 25, 2025). "Trump administration unveils new round of Medicare-negotiated drug prices." statnews.com
- CBS News. (November 6, 2025). "Trump announces deal to lower weight loss drug prices in some cases." cbsnews.com
- FDA. (March 8, 2024). "FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight." fda.gov
- Lincoff AM, et al. (2023). "Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes." N Engl J Med. 2023;389:2221-2232. SELECT trial (NCT03574597). nejm.org
- CMS. (December 23, 2025). "BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model." Announced as the planned permanent framework; on April 21, 2026 CMS declined to implement it in Part D for 2027 and extended the GLP-1 Bridge through Dec 31, 2027 instead. cms.gov
- CMS. (2026). "Coming Soon: $50 Monthly GLP-1 Access for Medicare Beneficiaries" / Medicare GLP-1 Bridge — Information for Prescribers and Beneficiaries. Bridge live July 1, 2026–December 31, 2027; $50 flat monthly copay (does not count toward deductible or OOP cap; LIS does not apply); BMI-based eligibility with prescriber prior authorization. cms.gov
- Mintz. (January 5, 2026). "The BALANCE Model and a New Wave of CMS Drug Pricing Models." BALANCE waives Part D weight-loss exclusion. mintz.com
- CMS. (June 2026). "Medicare GLP-1 Bridge — Information for Pharmacies." Covered drugs and forms: Wegovy (injection and pill), Foundayo, and the Zepbound KwikPen; Zepbound single-dose vials and single-dose pens are not covered. cms.gov
- Medicare.gov. (2026). "How much does Medicare drug coverage cost?" 2026 Part D deductible: $615; OOP cap: $2,100. medicare.gov
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