Does Medicare cover Wegovy for weight loss?

Not through Part D: the Social Security Act lets drug programmes exclude agents used for weight loss, and Part D does. Since 1 July 2026 the Medicare GLP-1 Bridge covers Wegovy for weight outside Part D, for $50 a month, until 31 December 2027.

Who qualifies for Wegovy through the Medicare GLP-1 Bridge?

Anyone 18 or older with Part D whose BMI is 35 or more; or 30 or more with diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease at stage 3a or worse; or 27 or more with prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms. Not if you have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease, or already get a GLP-1 through Part D.

Does the $50 Bridge copay count toward my Part D out-of-pocket cap?

No. The Bridge runs outside Part D, so the deductible does not apply and none of the $50 counts toward the cap. Wegovy covered by your Part D plan for heart disease does count toward it.

← Does Medicare cover it

Does Medicare cover Wegovy? Yes for heart risk (2026)

Wegovy is the drug that split the Medicare answer in two. In March 2024 the FDA added a cardiovascular indication, which is not weight loss, so a Part D plan can cover Wegovy for it. For weight alone it is still excluded, and that is the use the GLP-1 Bridge was built for.

Does Medicare cover Wegovy?

Yes to reduce the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and either obesity or overweight, and a Part D plan can put it on its formulary for that. For weight alone no Part D plan can. The Medicare GLP-1 Bridge covers Wegovy, injection or tablet, for $50 a month until 31 December 2027, if you meet its BMI criteria and do not have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease.

When Part D covers it: heart disease

The cardiovascular indication rests on the SELECT trial. In 17,604 adults with established cardiovascular disease, overweight or obesity and no diabetes, a heart attack, stroke or cardiovascular death happened to 6.5% of those on semaglutide 2.4 mg and 8.0% of those on placebo, over about 40 months.

The label also carries noncirrhotic MASH with moderate to advanced liver fibrosis, under accelerated approval. That is not weight loss either, so the statute does not exclude it, though each plan writes its own criteria for it.

The request has to name which of these it is for. A prior authorisation written for weight is refused however strong the heart history behind it; covered for the heart indication, what you pay counts toward the $2,100 out-of-pocket cap for 2026.

Read from FDA prescribing information for WEGOVY, via DailyMed and Social Security Act §1927(d)(2). Semaglutide for type 2 diabetes is Ozempic, which Part D covers as a diabetes drug. Medicare and Ozempic →

For weight alone: the GLP-1 Bridge

Wegovy is on it. Both forms. Medicare's list reads “Wegovy (injection or tablet)”, beside Foundayo and the Zepbound KwikPen.

It runs 1 July 2026 to 31 December 2027 at $50 a month. You must be 18 or older, have Medicare drug coverage, and when you start have one of:

a BMI of 35 or higher
a BMI of 30 or higher with diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure, or chronic kidney disease at stage 3a or worse
a BMI of 27 or higher with prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms

You are not eligible if a Part D plan already covers your GLP-1, or if you have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease — for those, Medicare's own page says, the route is your Part D plan.

Your prescriber sends the prescription and, when asked, a prior authorisation certifying that you are using the drug as part of a lifestyle programme focused on diet and exercise. Approval lasts through 31 December 2027, refills and dose changes included, unless you switch drug.

Weight loss drugs: the Medicare GLP-1 Bridge, Medicare.gov · Medicare GLP-1 Bridge, CMS, both read 10 September 2026.

What Wegovy costs on each route

Route	What you pay
Part D, for established heart disease	Your plan's tier for it; counts toward the $2,100 out-of-pocket cap for 2026
GLP-1 Bridge, for weight	$50 a month. The $50 sits outside Part D: the deductible does not apply, and none of it counts toward the out-of-pocket cap.
Manufacturer savings card	Not usable by anyone on Medicare — federal anti-kickback rules
Cash, no insurance	$349 a month once titrated, read from its own published page on 2026-09-10

Cash price checked 2026-09-10. It does not count toward the Part D cap.

If your plan says no

72 hours for a standard coverage determination and 24 for an expedited one; for an exception the clock starts when the prescriber's supporting statement arrives. 60 days from the notice to ask the plan for a redetermination, longer if you show good cause. 42 CFR 423.568; 42 CFR 423.572; 42 CFR 423.582

Model Coverage Determination Request Form, CMS — The form a Part D plan must accept for a coverage determination or exception request. CMS publishes it as a zip with the instructions; plans may use their own version, and yours must accept this one.
Exceptions, CMS — What a formulary exception is, and the deadlines a plan is held to: 72 hours for a standard request, 24 for an expedited one, counted from when the prescriber's supporting statement arrives rather than from your call.
Model Redetermination Request Form, CMS — The first-level appeal after a denial, effective 1 January 2025. You have 60 days from the denial notice.

At a denial, the appeal letter builder fills in the indication and the criterion; it runs in your browser and sends nothing.

Medicare and Zepbound →Medicare and Ozempic →Medicare and Mounjaro →Medicare and Wegovy pill →Every Medicare plan type →Wegovy savings, and who can use them →Medicaid, by state →

The law this page rests on

The exclusion is a statute, the Bridge is a CMS demonstration, and the cap is set each year by CMS.

Social Security Act §1927(d)(2), Office of the Law Revision Counsel — The statute itself, listing “agents when used for anorexia, weight loss, or weight gain” among the drugs a programme may exclude.
Manufacturer safeguards may not prevent copayment coupon use for Part D drugs, HHS Office of Inspector General — Why a manufacturer copay card cannot be used with a federal programme, from the office that enforces it.
Weight-loss drugs, Medicare.gov — Medicare's own page on what it does and does not cover for weight loss.

Medicare and Wegovy, answered

Does Medicare cover Wegovy for weight loss?: Not through Part D: the Social Security Act lets drug programmes exclude agents used for weight loss, and Part D does. Since 1 July 2026 the Medicare GLP-1 Bridge covers Wegovy for weight outside Part D, for $50 a month, until 31 December 2027.
Who qualifies for Wegovy through the Medicare GLP-1 Bridge?: Anyone 18 or older with Part D whose BMI is 35 or more; or 30 or more with diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease at stage 3a or worse; or 27 or more with prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms. Not if you have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease, or already get a GLP-1 through Part D.
Does the $50 Bridge copay count toward my Part D out-of-pocket cap?: No. The Bridge runs outside Part D, so the deductible does not apply and none of the $50 counts toward the cap. Wegovy covered by your Part D plan for heart disease does count toward it.