Does Medicare cover Wegovy?

Does Medicare cover Wegovy? Yes, through two routes, and which one you get depends on why it's prescribed (checked 10/18/2026). If you have heart disease, your Part D plan can cover Wegovy to lower your risk of a heart attack or stroke.

If Wegovy is prescribed for weight alone, regular Part D won't pay for it. A temporary program called the Medicare GLP-1 Bridge covers that use instead, for a $50 copay, from 07/01/2026 to 12/31/2027.

The two routes don't mix. The Centers for Medicare & Medicaid Services (CMS) keeps them apart on purpose, and that changes what you pay.

Why doesn't Part D cover Wegovy for weight loss?

Because federal law leaves it out. The Part D statute, 42 U.S.C. 1395w-102(e)(2)(A), excludes the drug uses that Medicaid may exclude under 42 U.S.C. 1396r-8(d)(2). First on that Medicaid list:

Agents when used for anorexia, weight loss, or weight gain.

Look at the words "when used for". The law targets the use, not the drug. That's how the same Wegovy pen can be covered for one diagnosis and refused for another.

CMS tried to change this once. In a proposed rule on 11/26/2024, it offered to reinterpret the statute to permit coverage of anti-obesity medications for the treatment of obesity.

That plan stalled. The final rule fact sheet of 04/04/2025 lists Part D coverage of anti-obesity medications among the proposals CMS did not finalize.

Will your Part D plan cover Wegovy for heart disease?

It should, if you fit the label. The FDA approved Wegovy on 03/08/2024 to lower heart risk in adults with heart disease who also have obesity or overweight. The current Wegovy label gives this use for both the injection and the tablets:

to reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight.

That approval came from the SELECT trial, which enrolled 17,604 people, according to its ClinicalTrials.gov record.

CMS has told plans that this use stays with them. Its 06/10/2026 memo to Part D plans uses Wegovy for heart risk as its example. People prescribed it for that use should continue to receive coverage through Medicare Part D.

The memo treats MASH the same way. That's a liver disease Wegovy is also approved to treat, and those requests go to your Part D plan too.

On this route you pay your plan's price, not $50. CMS says plans are not required to change existing cost-sharing for GLP-1 drugs to align with the Medicare GLP-1 Bridge $50 co-pay. Your copay depends on where Wegovy sits on your plan's drug list.

Expect some paperwork. CMS says the prescriber must complete the applicable utilization management requirements through your plan. That can include prior authorization, where your prescriber shows the plan you meet its rules before it pays.

If Wegovy isn't on your plan's drug list at all, ask about a formulary exception. CMS's memo says plans must keep following their existing exception process for these requests.

Who qualifies for the Medicare GLP-1 Bridge?

The Bridge is for Wegovy prescribed to lose weight and keep it off. Medicare.gov says you must be 18 or older and meet one of these when you start:

• A body mass index (BMI) of 35 or higher.
• A BMI of 30 or higher and one of: heart failure with preserved ejection fraction, uncontrolled high blood pressure, or kidney disease at stage 3a or higher.
• A BMI of 27 or higher and one of: prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms.

You also need Medicare drug coverage. The CMS fact sheet for prescribers lists plan types that don't count on their own, such as private fee-for-service plans and PACE. If you also have a standalone drug plan, you can still qualify.

Three groups can't use the Bridge, even if they meet the BMI rules:

• People with type 2 diabetes, moderate-to-severe sleep apnea or MASH. Their Part D plan handles GLP-1 requests.
• People who have already received a GLP-1 through their Part D plan in 2026.
• People prescribed Wegovy for a use Part D already covers, such as heart risk.

That last rule holds even when the Bridge would cost you less. CMS's memo says Bridge eligibility is irrespective of any cost sharing differential between Part D plan coverage and Medicare GLP-1 Bridge coverage. So a plan copay above $50 isn't a reason you can switch.

How much does Wegovy cost through the Bridge?

It's $50 a fill (checked 10/18/2026). Medicare.gov says that pays for a one-month supply of 28 or 30 days, depending on the drug.

Wegovy injection and tablets are both on the list. So are Foundayo tablets and the Zepbound KwikPen, but not Zepbound single-dose pens or vials.

The $50 sits outside your Part D plan. The CMS Bridge page says the Part D deductible doesn't apply and none of the copay counts toward your true out-of-pocket costs. Medicare.gov adds that Extra Help can't lower it.

The copay doesn't change with your phase of the Part D benefit, per CMS's memo. The same memo says the drug makers supply Bridge drugs at a net price of $245 a month.

Only 28-day or 30-day fills are covered. A 90-day supply at $50 isn't an option.

How do you get Wegovy through the Bridge?

Your prescriber starts it, and the order of steps matters. The CMS fact sheet for prescribers sets them out:

1. The prescriber sends the prescription with an obesity diagnosis code (the E66 family) and the note SEND TO BRIDGE FOR WEIGHT MANAGEMENT.
2. The pharmacy sends the claim to the Bridge, and Medicare checks that you're eligible.
3. If you are, the pharmacy sends your prescriber a prior authorization form, typically within 24 to 72 hours.
4. You get the decision by mail, and your prescriber gets it within 72 hours of sending the form.

Without that note, the pharmacy may bill your Part D plan instead. CMS warns the plan may then reject the claim or start its own prior authorization.

Medicare.gov says your provider must certify that you're using the drug as part of a diet and exercise program. Once approved, the authorization lasts through 12/31/2027, refills and dose changes included. Switching to a different GLP-1 needs a new one.

Can you use the Wegovy savings card or Novo's cash price on Medicare?

Not the savings card. Novo's offer terms rule out anyone enrolled in a federal or state program with drug coverage, Medicare included.

Cash is different. NovoCare Pharmacy says Government-insured patients may use this program if they self pay and process outside of their insurance.

The catch is that cash doesn't move you toward any Medicare limit. Novo's terms ask Medicare enrollees to agree: You will not attempt to count the cost of this medicine toward your insurance deductible or out-of-pocket limit.

If you qualify for the Bridge, $50 beats $349 by a wide margin. Cash makes the most sense if neither Medicare route is open to you. Our Wegovy price check lists every self-pay price.

Does Medicaid cover Wegovy?

It depends on your state. The same federal list that shapes Part D allows each state's Medicaid program to leave out or restrict weight-loss drugs. Your state Medicaid office can tell you which Wegovy uses it pays for.

What happens to the Bridge after 2027?

It's set to end on 12/31/2027. CMS extended it to that date because a planned Part D payment model, called BALANCE, isn't launching in 2027.

The CMS Bridge page says the extra time lets it gather data for plans ahead of potential implementation of BALANCE in Part D. Nothing after 2027 is settled yet.

How we checked these rules

We read the CMS and Medicare.gov pages, the FDA label, Novo Nordisk's terms and the statute text on 10/18/2026. Every rule above links to the page it came from. If a rule or price moves, the fix gets a date here and a line in our price change log.