Does Medicare Cover Wegovy? Coverage Rules, Costs, and the New GLP-1 Bridge

Wegovy and Ozempic are both brand-name medications manufactured by Novo Nordisk. Both contain semaglutide, a GLP-1 receptor agonist that works by mimicking a hormone that regulates appetite and blood sugar. Despite sharing an active ingredient, they are distinct FDA-approved products with different indications, dosing schedules, and coverage rules.

The higher dose in Wegovy is what makes it more effective for weight loss in clinical trials. The SELECT trial, published in the New England Journal of Medicine, found that Wegovy reduced the risk of major cardiovascular events by 20 percent in adults with obesity and established cardiovascular disease. That trial result is what opened the door to Part D coverage for cardiovascular risk reduction.

In 2024, CMS issued guidance allowing Medicare Part D plans to cover semaglutide (Wegovy) for a specific indication: cardiovascular risk reduction in adults with established cardiovascular disease and a BMI of 27 or higher. This guidance was based on the SELECT trial results and the FDA approval of Wegovy for this indication.

Who qualifies for Part D coverage of Wegovy:

Important limitations: Not every Part D plan covers Wegovy even for this indication. Plans are not required to include it on their formulary. If your plan does not cover it, you can request a formulary exception, switch plans during the Annual Enrollment Period, or explore the GLP-1 Bridge pathway described below.

Tier placement and cost: When Part D plans do cover Wegovy, it is typically placed on Tier 4 or Tier 5 (specialty tier), which means significant cost-sharing. With a list price of approximately $1,350 per month, you could reach the $2,100 Part D out-of-pocket cap within the first two months of the year. After that, Wegovy costs $0 for the rest of the year.

For a detailed explanation of how the Part D benefit phases affect your drug costs, see our guide to understanding Medicare Part D coverage and costs.

The Medicare GLP-1 Bridge, which launched July 1, 2026, is the most significant expansion of Medicare access to Wegovy for beneficiaries who do not have established cardiovascular disease. The program runs through December 31, 2027, and covers Wegovy at a flat $50 monthly copay.

Who qualifies for Wegovy through the Bridge:

Who is excluded from the Bridge: Beneficiaries with a diagnosis of type 2 diabetes, obstructive sleep apnea, or noncirrhotic MASH are not eligible because they have existing Part D coverage pathways for GLP-1 medications. Additionally, if you have already filled a GLP-1 prescription through your Part D plan in 2026, you are not eligible for the Bridge in 2026.

How the $50 copay works: The Bridge operates entirely outside of the Part D benefit. The $50 monthly copay does not count toward your Part D deductible or the $2,100 annual out-of-pocket cap. Low-Income Subsidy (Extra Help) protections also do not apply, meaning LIS beneficiaries still pay the full $50.

For a complete breakdown of the Bridge program, eligibility tiers, and the prior authorization process, see our dedicated guide to the Medicare GLP-1 Bridge Program.

The two coverage pathways for Wegovy serve different patient populations and have meaningfully different cost structures. Understanding which one applies to you depends on your diagnosis and current Part D plan.

A note on the $50 Bridge copay vs. Part D cost-sharing: For beneficiaries who qualify for both pathways, the math is not always straightforward. If your Part D plan covers Wegovy on a high tier, you might spend $300 to $500 per month before reaching the out-of-pocket cap. The $50 Bridge copay is lower, but it does not count toward the cap, meaning you pay $50 every month for 18 months with no relief. If you reach the Part D cap quickly due to other expensive medications, the Part D pathway may actually be cheaper overall. A licensed Medicare specialist can run the numbers for your specific situation.

Wegovy has a list price of approximately $1,350 per month without insurance. Under Medicare, your actual cost depends on which coverage pathway applies.

The Inflation Reduction Act and the $2,100 cap: Starting in 2026, the annual out-of-pocket cap for Medicare Part D is $2,100. For a drug as expensive as Wegovy, beneficiaries who access it through Part D and have other high-cost medications may reach this cap relatively quickly. Once you hit $2,100 in out-of-pocket drug costs for the year, all covered Part D drugs cost $0 for the remainder of the year.

The Medicare Prescription Payment Plan (M3P): If you access Wegovy through Part D, the M3P program allows you to spread your drug costs across monthly installments throughout the year. This does not reduce your total annual cost but can help with cash flow in the early months when costs are highest.

For more detail on how the Part D benefit phases and the $2,100 cap affect your overall drug spending, see our guide to Medicare out-of-pocket costs.

The process for getting Wegovy covered differs depending on which pathway applies to you.

If you are pursuing the GLP-1 Bridge pathway:

If you are pursuing the Part D cardiovascular risk reduction pathway:

If neither pathway applies: If you do not qualify for the Bridge and your diagnosis does not meet the cardiovascular risk reduction criteria, standard Part D does not cover Wegovy for weight loss alone. In that case, ask your doctor about covered alternatives, check whether manufacturer patient assistance programs apply (note: these typically exclude Medicare beneficiaries), or revisit your options during the next Annual Enrollment Period.

For help comparing Part D plans that cover your medications, schedule a free consultation with our licensed specialists.

Because Wegovy and Ozempic contain the same active ingredient, beneficiaries often wonder whether they can substitute one for the other to get better coverage. The answer is that coverage is tied to the FDA-approved indication, not the active ingredient. You cannot use Ozempic's diabetes coverage to get Wegovy, and you cannot use Wegovy's weight management coverage to avoid a diabetes prior authorization for Ozempic.

For a full comparison of Medicare coverage across all GLP-1 medications, see our guides to Medicare coverage for Ozempic and Medicare coverage for Zepbound.

The Medicare GLP-1 Bridge is explicitly a short-term demonstration. It is scheduled to end December 31, 2027, and CMS has not announced a permanent replacement. This raises an important question for beneficiaries who begin Wegovy through the Bridge: what happens to their access and their health progress when the program ends?

CMS is collecting utilization and outcomes data during the Bridge period to inform a potential longer-term coverage expansion. The BALANCE Model, which was originally designed as the successor to the Bridge, was delayed and has not been rescheduled. Congressional legislation to permanently expand Medicare obesity drug coverage has been introduced in multiple sessions but has not been enacted as of mid-2026.

For beneficiaries starting Wegovy through the Bridge, it is worth discussing with your doctor what a transition plan might look like if the program ends without a permanent replacement. Options could include transitioning to a Part D-covered indication if your health status changes, exploring Medicare Advantage plans that may offer supplemental obesity drug coverage, or reviewing whether the cardiovascular risk reduction pathway becomes applicable as your treatment progresses.

Our guide to Medicare Advantage vs. Medigap explains how Medicare Advantage plans differ from Original Medicare and how supplemental benefits work, which is relevant if you are evaluating whether a plan switch might improve your drug coverage options.

For the most current information on the Bridge program and any extensions, visit the official CMS Medicare GLP-1 Bridge page.