Quick Answer
No - Medicare Part D does not currently cover Wegovy (semaglutide) when prescribed solely for weight loss. Federal law has historically prohibited Medicare Part D from covering weight-loss drugs. However, Ozempic (the same active ingredient, semaglutide) is covered by Medicare Part D when prescribed for type 2 diabetes. If you have heart disease, Medicare may cover Wegovy under a separate indication - CMS issued guidance in 2024 allowing coverage for cardiovascular risk reduction.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Medicare Part D (Weight Loss) | Not Covered | Federal law prohibits Part D coverage for weight-loss drugs |
| Medicare Part D (Cardiovascular Risk) | Covered (2024+) | CMS approved coverage for cardiovascular risk reduction in 2024 |
| Medicare Part D (Ozempic for Diabetes) | Covered | Ozempic (same drug) is covered when prescribed for type 2 diabetes |
| Medicare Advantage (Part C) | Not Covered for Weight Loss | Same restrictions as Part D apply; cardiovascular indication may be covered |
Understanding Your Coverage Options
Medicare Part D (Prescription Drug Coverage)
Not covered for weight loss; covered for cardiovascular risk reductionMedicare Part D does not cover Wegovy when prescribed for weight loss. A longstanding federal law (Social Security Act §1927) prohibits Medicare Part D from covering drugs used for weight loss, weight gain, or anorexia. Wegovy (semaglutide 2.4 mg) is FDA-approved for chronic weight management, which places it in this excluded category.
However, in 2024 the FDA approved Wegovy for a second indication: reducing the risk of serious cardiovascular events (heart attack, stroke, cardiovascular death) in adults with established cardiovascular disease and obesity or overweight. CMS issued guidance in 2024 allowing Medicare Part D plans to cover Wegovy for this cardiovascular indication. If your doctor prescribes Wegovy specifically for cardiovascular risk reduction - not weight loss - your Part D plan may cover it.
Ozempic (semaglutide 0.5–2 mg) is a different formulation of the same drug (semaglutide) approved for type 2 diabetes. Medicare Part D covers Ozempic when prescribed for diabetes. If you have both obesity and type 2 diabetes, your doctor may prescribe Ozempic for diabetes management, which would be covered by Part D.
What It Covers
- Wegovy for cardiovascular risk reduction (2024 CMS guidance)
- Ozempic (semaglutide) when prescribed for type 2 diabetes
- Other GLP-1 medications approved for diabetes (Ozempic, Trulicity, Victoza)
What It Doesn't Cover
- Wegovy prescribed solely for weight loss
- Other weight-loss drugs (Qsymia, Contrave, Saxenda for weight loss only)
- Over-the-counter weight-loss supplements
Wegovy costs approximately $1,350/month without coverage. With Part D coverage for cardiovascular indication, your cost depends on your plan's formulary tier and cost-sharing. The IRA's $2,000 annual out-of-pocket cap (2025) applies to all Part D drugs.
Medicare Advantage (Part C)
Same restrictions as Part D applyMedicare Advantage plans with prescription drug coverage (MA-PD plans) follow the same federal rules as standalone Part D plans. Wegovy is not covered for weight loss under Medicare Advantage drug benefits.
For the cardiovascular risk reduction indication, some Medicare Advantage plans may cover Wegovy following the 2024 CMS guidance. Check your plan's formulary or call your plan to confirm whether Wegovy is covered for your specific diagnosis.
What It Covers
- Wegovy for cardiovascular risk reduction (if plan covers it)
- Ozempic for type 2 diabetes
What It Doesn't Cover
- Wegovy for weight loss
- Weight-loss drugs as a general category
Ask Your Doctor about the Cardiovascular Indication
If you have established cardiovascular disease and are overweight or obese, ask your doctor whether Wegovy's cardiovascular risk reduction indication applies to you. This may allow Medicare Part D to cover the drug.
Medicare Supplement (Medigap)
Medigap does not cover prescription drugsMedicare Supplement (Medigap) plans do not cover prescription drugs. Medigap supplements Original Medicare (Part A and Part B) - it does not add drug coverage. For prescription drug coverage, you need a separate Medicare Part D plan.
Medigap also does not cover drugs that are excluded from Medicare coverage, such as Wegovy for weight loss. If Wegovy becomes covered under Part D for a specific indication, Medigap would not apply - Part D has its own cost-sharing structure.
What It Covers
- Part B coinsurance for covered medical services
- Hospital costs under Part A
What It Doesn't Cover
- Prescription drugs (including Wegovy)
- Drugs excluded from Medicare coverage
Medigap does not cover Wegovy or any other prescription drug. You need a separate Medicare Part D plan for drug coverage.
✦ Legislative & Regulatory Updates on Wegovy Coverage
2024 CMS Guidance: Cardiovascular Indication
PassedCMS issued guidance in 2024 allowing Medicare Part D plans to cover Wegovy for cardiovascular risk reduction in adults with established cardiovascular disease and obesity or overweight. This followed FDA approval of this new indication.
Treat and Reduce Obesity Act (TROA)
PendingThe Treat and Reduce Obesity Act would remove the federal prohibition on Medicare Part D coverage for FDA-approved weight-loss drugs. The bill has been introduced in multiple congressional sessions but has not yet passed.
IRA $2,000 Out-of-Pocket Cap
PassedThe Inflation Reduction Act established a $2,000 annual out-of-pocket cap for Medicare Part D beneficiaries starting in 2025. If Wegovy becomes covered, this cap would limit your annual drug costs.
Alternatives and Cost-Saving Options
If Medicare does not cover Wegovy for your situation, there are several ways to reduce your costs or access alternative treatments.
Options to Consider:
- Ask your doctor about Ozempic (semaglutide for diabetes) if you have type 2 diabetes - it is covered by Part D
- Ask about the cardiovascular indication for Wegovy if you have heart disease
- Check Novo Nordisk's patient assistance program (NovoCare) for income-based discounts
- Ask your doctor about other GLP-1 medications covered by your Part D plan
- Consider Medicare's covered obesity counseling (22 sessions/year under Part B)
- Check if your state Medicaid program covers Wegovy (rules vary by state)
- Ask your pharmacist about manufacturer coupons or discount programs
- Compare Part D plans during open enrollment to find the best formulary for your medications
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.