Does Medicare Cover Wegovy?

Why Medicare won't pay for Wegovy for weight loss

Federal law specifically excludes drugs used for weight loss from Medicare Part D coverage. This is not a decision your plan makes — it is written into the Social Security Act. When Part D was created by the Medicare Modernization Act of 2003, it adopted an existing Medicaid rule that bars coverage of "agents when used for anorexia, weight loss, or weight gain."

Because Wegovy's original FDA approval was for chronic weight management, that use falls squarely inside the exclusion. So if your only reason for taking Wegovy is to lose weight, standard Part D cannot pay for it — no matter which plan you have.

Regulators looked at changing this. In the Contract Year 2026 final rule, CMS proposed but ultimately declined to add broad Medicare coverage of anti-obesity medications for weight loss. That means the weight-loss exclusion remains in force, except for the time-limited GLP-1 Bridge demonstration described below.

When Part D CAN cover Wegovy: the heart-disease indication

Part D is allowed to cover an anti-obesity drug when it is prescribed for a separate, FDA-approved reason other than weight loss — what the rules call a "medically accepted indication." In March 2024, Wegovy got exactly such a reason.

On March 8, 2024, the FDA approved Wegovy to reduce the risk of cardiovascular death, heart attack, and stroke in adults who have established cardiovascular disease plus obesity or overweight. It was the first weight-loss drug approved to also prevent these life-threatening heart events. Shortly afterward, CMS told Part D plans they MAY cover Wegovy for this cardiovascular use, because reducing heart risk is a medically accepted indication distinct from weight loss.

"May" is the key word. Coverage is at each plan's discretion. For your plan to pay, it has to list Wegovy on its formulary (drug list), and plans commonly apply utilization management — prior authorization, step therapy, or quantity limits — to confirm you are taking it for the heart indication rather than for weight loss alone.

• You generally need established cardiovascular disease (such as a prior heart attack or stroke) plus obesity or overweight.
• Your specific Part D or Medicare Advantage drug plan must include Wegovy on its formulary.
• Expect prior authorization paperwork from your prescriber documenting the cardiovascular reason.
• Coverage, cost, and rules vary plan by plan — always check your plan's formulary and Evidence of Coverage.

The Medicare GLP-1 Bridge: a $50 copay for 2026-2027

CMS launched a temporary demonstration called the Medicare GLP-1 Bridge that, for the first time, gives some Medicare beneficiaries access to GLP-1 drugs specifically for weight reduction. It runs from July 1, 2026 through December 31, 2027. Covered drugs include Wegovy (injection and tablets), Zepbound KwikPen, and Foundayo.

Under the Bridge, eligible beneficiaries pay a flat $50 copay per monthly supply. Importantly, the Bridge operates outside the normal Part D benefit: the Part D deductible does not apply, and the $50 copay does NOT count toward your Part D out-of-pocket cap (TrOOP). Extra Help / the low-income subsidy is not provided under the Bridge. Participating manufacturers supply the drugs at a net price of $245 per monthly supply.

This is a short-term program. Because it is set to end on December 31, 2027, anyone relying on it for weight-loss coverage should plan for what happens afterward — at that point, coverage would again be limited to a qualifying non-weight-loss indication unless the rules change.

• Be enrolled in an eligible Part D plan and be at least 18 years old.
• Use the GLP-1 for weight reduction or to maintain weight reduction.
• Meet one of these clinical paths: BMI 27 or higher with prediabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease; OR BMI 35 or higher; OR BMI 30 or higher with heart failure, uncontrolled hypertension, or chronic kidney disease (stage 3a or higher).

Part B or Part D? How Wegovy fits into Medicare

Wegovy is a self-administered prescription drug, so it falls under Part D (prescription drug coverage) — not Part B. Original Medicare (Parts A and B) does not cover Wegovy at all. Any coverage comes through a stand-alone Part D drug plan or a Medicare Advantage plan that includes drug coverage (often called an MA-PD plan).

This matters because if you only have Original Medicare without a drug plan, there is no path to Wegovy coverage through Medicare. To have any chance of coverage — whether for the cardiovascular indication or through the GLP-1 Bridge — you need Part D drug coverage in place.

What Wegovy could cost you under Medicare in 2026

Your out-of-pocket cost depends entirely on which coverage path applies. There are two very different scenarios.

If Wegovy is covered under standard Part D for the cardiovascular indication, normal Part D cost-sharing applies. That means your plan's deductible, copays or coinsurance, and the 2026 Part D annual out-of-pocket cap of $2,100 all come into play. (For reference, the 2026 national base beneficiary premium is $38.99 per month, though your actual plan premium may differ.) Once your true out-of-pocket spending reaches $2,100 in a calendar year, you pay nothing more for covered Part D drugs that year.

If you qualify through the GLP-1 Bridge instead, you pay the flat $50 per month — but remember that amount does not count toward the $2,100 Part D cap, the Part D deductible does not apply, and Extra Help does not reduce it further.

• Cardiovascular indication (standard Part D): your plan's normal copay/coinsurance, capped by the 2026 $2,100 annual out-of-pocket maximum.
• GLP-1 Bridge (weight reduction): flat $50 per monthly supply, separate from the Part D cap and deductible.
• Weight loss only, outside the Bridge: not covered — you would pay the full retail price.

How this compares to Ozempic, Zepbound, and Mounjaro

The same legal principle applies to other GLP-1 drugs: Medicare cannot cover them when the only purpose is weight loss, but it can cover them for a separate FDA-approved indication. For example, a drug approved to treat type 2 diabetes can be covered under Part D for diabetes — that is a medically accepted indication, not weight loss. So if you have type 2 diabetes, your plan may cover an appropriate GLP-1 medication for that condition, subject to its formulary and rules.

The GLP-1 Bridge demonstration covers certain specific products (Wegovy injection and tablets, Zepbound KwikPen, and Foundayo) for weight reduction during the 2026-2027 window. Whether any particular drug and dose are covered for you depends on your plan's formulary, the indication, and the Bridge's eligibility criteria. Coverage and prior-authorization rules vary by plan, so confirm the details in your plan's Evidence of Coverage before you assume anything is or isn't covered.