Is Wegovy covered by Medicare?

Medicare Part D prescription plans will start covering the weight loss drug Wegovy when patients also have documented heart disease, according to the U.S. Centers for Medicare and Medicaid Services (CMS).

The new policy was announced after the U.S. Food and Drug Administration (FDA) announced approval on March 8, 2024 of Wegovy (semaglutide) to reduce the risk of heart attack, stroke, and heart-related death in adults who are obese or overweight and have cardiovascular (heart) disease.

Wegovy is also approved for weight loss management in adults who are obese (body mass index [BMI] of 30 kg/m2 or greater) or overweight (BMI of 27 kg/m2 or greater) and have weight-related medical problems (high blood pressure, type 2 diabetes, or high cholesterol).

Wegovy is also approved to be used by people 12 years and older who are obese (initial BMI 95th percentile or greater for age and sex) for chronic weight management.

Wegovy should be used in addition to a reduced-calorie diet and increased physical activity for all approved indications.

You can also use the online resources available at Wegovy.com to check to see if it is covered under your Part D insurance plan, your estimated costs, and if you are eligible for additional savings from Novo Nordisk.

Always check with your prescription insurance plan to confirm coverage and costs.

Wegovy is classified as a glucagon-like peptide-1 (GLP-1) receptor agonist and is given as a self-administered subcutaneous (under the skin) injection once weekly for long-term weight loss and to help protect the heart.

Learn more: How do you get Wegovy covered by insurance?

How much will Wegovy cost on Medicare?

The exact cost for Wegovy when covered by Medicare Part D is not yet fully known and will vary based on your prescription benefits. This includes any medical deductible, coinsurance or copay you may have to pay based on your plan, and whether or not you are in the coverage gap.

In addition, Medicare may require that people must meet certain criteria to control Wegovy usage, such as:

• step therapy (use of other treatments in stepwise fashion before use of Wegovy)
• higher out-of-pockets fees
• prior authorization, which involves paperwork your doctor must complete to state your eligibility for treatment.

Related: How much does semaglutide (Wegovy) cost?

Related questions

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What if my Medicare Plan does not cover Wegovy?

Wegovy is an expensive medicine so you will most likely need to seek out additional financial sources or other options, such as patient assistance from the manufacturer, using a more affordable medicine or one that is covered by your insurance, or using a discount coupon if you pay cash for Wegovy.

Based on the Drugs.com Price Guide, the cost for Wegovy injection is around $1,430 for a supply of 4 injectable pens that contain a month's supply of medicine. Price can vary depending on your location and the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

If Wegovy is not covered by your insurance, and you have run out of other options, consider these options:

• Contact NovoCare at 1-888-793-1218 (Monday-Friday, 8:00 am-8:00 pm ET) to learn about any financial assistance programs you may qualify for. If you pay cash for your prescriptions, you can save up to $500 per 28-day supply (1 box) of Wegovy.
• Ask your insurance plan if other weight loss medications are covered. Discuss these different options with your healthcare provider to determine if any may be a reasonable substitute for Wegovy.
• Consider using an online coupon such as the Drugs.com Wegovy discount card which is accepted at most U.S. pharmacies. This may save you some money.

The Wegovy price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies, and may help you save money.

In addition, for cash-paying customers without any type of insurance at all, you may be able to access any dose strength of Wegovy through the NovoCare Pharmacy. NovoCare Pharmacy provides direct-to-patient, convenient home shipments of Wegovy single-dose pens at a reduced cost of $499 per month. This offer is available for uninsured patients or eligible patients with commercial insurance who do not have coverage for obesity medicines.

Visit the Drugs.com Price Guide to learn more about Wegovy Prices, Coupons and Patient Assistance programs. The Wegovy price guide is based on using the Drugs.com discount card.

This is not all the information you need to know about Wegovy (semaglutide) for safe and effective use and does not take the place of your doctor’s directions. Prices and coverages are subject to change. Review the full Wegovy information and discuss this information and any questions you have with your doctor or other health care provider.