Does Medicare cover the Wegovy pill? Heart risk: yes (2026)
The tablet, approved on 22 December 2025, shares one label with the Wegovy pen, so most of its Medicare answer is the pen's. The difference is one indication: the tablet is not approved for MASH, and it is approved only for adults.
Does Medicare cover Wegovy pill?
Yes for the same cardiovascular indication as the injection — to reduce heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and obesity or overweight — which a Part D plan can cover. For weight alone it is excluded from Part D. The Medicare GLP-1 Bridge lists “Wegovy (injection or tablet)”, so the tablet is covered there for $50 a month until 31 December 2027 if you meet its criteria.
When Part D covers it: heart disease, not MASH
The tablet and the pen share a label with separate indication lists. The tablet carries cardiovascular risk reduction and chronic weight management in adults; it does not carry the MASH indication the injection has, and it is not approved for anyone under 18.
So the one non-weight route to Part D coverage for the tablet is established cardiovascular disease. A request for the tablet on the liver indication has no FDA indication to rest on, where the same request for the injection does.
It is one of two pills on the Bridge. The other is Foundayo (orforglipron), which Medicare lists as a tablet too.
Read from FDA prescribing information for WEGOVY (injection and tablets), via DailyMed and Social Security Act §1927(d)(2). The injection shares this label and adds the MASH indication. Medicare and Wegovy →
For weight alone: the GLP-1 Bridge
Wegovy pill is on it. Yes: Medicare's list reads “Wegovy (injection or tablet)”. The copay is the same $50 whichever form you take.
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 pill 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 | $299 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.
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 pill, answered
- Does Medicare cover the Wegovy pill for weight loss?
- Not through Part D. Through the Medicare GLP-1 Bridge, yes: it lists Wegovy injection or tablet, for $50 a month from 1 July 2026 to 31 December 2027, for people 18 or older with Part D who meet its BMI criteria.
- Is the Wegovy pill cheaper than the injection on Medicare?
- On the Bridge they cost the same, $50 a month. Covered by a Part D plan for heart disease, the price depends on the tier your plan puts each on, which its formulary shows. Paying cash, NovoCare prices the tablet by dose; the figures and the date they were read are in the cost table above.
- Which pills does the Medicare GLP-1 Bridge cover?
- Two: the Wegovy tablet and Foundayo. Rybelsus, the diabetes semaglutide tablet, is not on the Bridge; Part D covers it for type 2 diabetes.