Wegovy is a weight loss drug that is also indicated to reduce the risk of heart attack and stroke. Medicare coverage for Wegovy through Part D prescription drug plans may vary.
Medicare Part D prescription drug plans may pay for certain medications used to treat heart disease. However, there are limitations.
Wegovy is a medication for treating obesity. However, in 2024, the Food and Drug Administration (FDA) approved the drug for heart disease. These changes in indications have affected insurance coverage, including Medicare.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
In March 2024, the
Medicare does not cover antiobesity medications, so it is helpful to understand that Wegovy coverage is still not available for weight loss itself. Criteria for coverage include a medically acceptable indication, which is a diagnosis of cardiovascular disease.
Medicare Part D covers Wegovy because it is a take-home, self-administered, injectable medication. Individuals who do not have a Part D drug plan will not have coverage through Medicare Part B, which covers limited outpatient and physician-administered medications.
According to KFF data analysis from 2020, an estimated 3.6 million, maybe more, Medicare beneficiaries had a confirmed diagnosis of overweight or obesity, and cardiovascular disease. Wegovy’s new indication may open up coverage of the drug for those with Medicare coverage.
Those who have a Medicare Advantage plan instead of Original Medicare (parts A and B) should check with their plan provider for coverage details. Many Medicare Advantage plans include prescription drug coverage, but the medications covered and associated costs may vary by plan.
Why Medicare does not typically cover antiobesity drugs
The Medicare Modernization Act of 2003 prohibits Medicare from covering weight loss drugs. This act remains in effect, so Medicare will not cover Wegovy for people without a cardiovascular disease diagnosis.
The exact cost of Wegovy when covered by Medicare Part D may vary based on the specific prescription benefit offered. Medicare Part D plans may have different deductibles and copays.
Some plans may also cover Wegovy as a specialty or higher-tier drug, which may mean that some Part D plans charge a higher copayment.
The general cost of Wegovy for people with Medicare Part D coverage may include a monthly out-of-pocket expense of $325 to $430, according to KFF, which may be a percentage of the $1,300 list price.
Out-of-pocket expenses are the portion of the cost an individual is responsible for. In 2025, Medicare caps out-of-pocket drug costs at $2,000.
Wegovy is a glucagon-like-peptide-1 (GLP-1) receptor agonist, a class of medications used to treat diabetes and obesity. Wegovy, which is the brand name for the medication, contains the active ingredient semaglutide.
Wegovy acts like a GLP-1 hormone, which works in the brain to regulate a person’s appetite. It also appears to slow down how fast food moves through the digestive system, making someone feel full longer. This combination helps reduce food and calorie intake, leading to weight loss and weight management over time.
Wegovy comes as a prefilled liquid solution that is self-administered via a single-dose injection pen.
Obesity is a
Researchers continue to investigate the exact reason Wegovy may help reduce heart disease. However, some studies indicate it may have certain protective mechanisms that reduce the risk of heart disease.
For instance,
A 2023 double-blind, placebo-controlled trial found that a 2.4 mg weekly dose of semaglutide was better than the placebo in reducing the incidence of nonfatal heart attack and stroke and the incidence of death from cardiovascular causes in adults ages 45 years or older. Participants involved in the study had confirmed diagnoses of cardiovascular disease and obesity or overweight, but they did not have diabetes.
If an individual does not have a heart disease diagnosis, Medicare will not cover the drug for weight loss. However, there may be other options available for getting Wegovy.
Wegovy is currently only available as a brand-name medication. This means there is no generic option. Generic drugs have the same active ingredient as the brand-name medication and are usually less expensive.
However, cost-saving measures may be a possibility for people who do not have Medicare coverage for Wegovy. A person can consider the following options:
- Look for a savings card: One option may include enrolling in the Wegovy savings card program. This card is available to individuals with or without insurance coverage. Information on a savings card is available on the manufacturer’s website.
- Check out other prescription discount cards: Various companies also offer prescription discount cards, which provide savings on medications.
- Try a mail-order pharmacy: The pharmacy you use may also affect the cost of Wegovy. Mail-order pharmacies may be less expensive than traditional pharmacies.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
The law prohibits Medicare from covering medications specifically for weight loss. However, the FDA expanded the indication for the weight loss drug Wegovy.
Guidance now allows Medicare Part D prescription plans to cover Wegovy to help prevent heart attack and stroke in people who are overweight or have obesity and have a diagnosis of heart disease.
The exact cost of Wegovy to an individual may vary depending on the Part D plan. For people who do not have a diagnosis of heart disease and do not have coverage, cost-saving prescription cards or other discount programs may be an option for getting Wegovy.