Wegovy (semaglutide 2.4 mg) is a weekly injectable medication approved by the FDA for chronic weight management and, since March 2024, for reducing the risk of major cardiovascular events in adults with heart disease who are overweight or obese. That second FDA approval changed the Medicare coverage calculus entirely. Whether Medicare covers Wegovy for you depends on your diagnosis, your BMI, and which type of Medicare you have.
This guide explains the cardiovascular coverage path, the 2026 GLP-1 Bridge program that opens a second coverage route starting July 1, what Wegovy costs under each scenario, and your options if you don't qualify for either.
Coverage Breakdown
Medicare Part D Coverage for the Cardiovascular Indication
In March 2024, the FDA approved Wegovy to reduce the risk of major adverse cardiovascular events (MACE) in adults with established cardiovascular disease who are overweight or obese. CMS simultaneously announced that Part D plans may cover Wegovy for this indication, sidestepping the Medicare Modernization Act of 2003 prohibition on weight-loss drug coverage because the cardiovascular use is medically accepted and not classified as a weight-loss drug.
To qualify for Part D coverage under the cardiovascular indication, you must have all three of the following:
- Established cardiovascular disease: a prior heart attack (myocardial infarction), a prior stroke, or symptomatic peripheral arterial disease
- BMI of 27 or higher (overweight or obese)
- A prescription from your provider written specifically for the cardiovascular indication (not for weight loss)
The Medicare GLP-1 Bridge Program (July 1, 2026 to December 31, 2027)
Starting July 1, 2026, CMS launched the Medicare GLP-1 Bridge, a short-term demonstration program that expands access to Wegovy for obesity (without requiring a cardiovascular disease diagnosis) at a flat $50 per month copay. The Bridge covers all formulations of Wegovy and Foundayo, plus the KwikPen formulation of Zepbound.
The three BMI tiers that qualify for the Bridge program are:
- BMI 35 or higher, with no additional diagnosis required
- BMI 30 or higher with a diagnosis of heart failure with preserved ejection fraction (HFpEF), uncontrolled hypertension (systolic above 140 on two medications), or chronic kidney disease stage 3a or above
- BMI 27 or higher with pre-diabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease
What the $50 Bridge Copay Actually Means for Your Budget
The $50 monthly Bridge copay is significantly below Wegovy's 2026 list price of $1,349 per month. However, it comes with a structural catch: that $50 does not count toward your Part D annual deductible and does not count toward the $2,100 annual out-of-pocket spending cap that applies to standard Part D drugs starting in 2026.
Low-income subsidy (Extra Help) recipients do not get a reduced copay under the Bridge; the $50 flat rate applies to everyone. If you qualify for Wegovy under the cardiovascular Part D coverage pathway instead, your standard Part D cost-sharing applies and those costs do count toward your $2,100 cap. Novo Nordisk's NovoCare savings program is not available to Medicare beneficiaries, so the $50 Bridge copay or standard Part D cost-sharing are your primary cost-reduction options.
Why Medicare Cannot Cover Wegovy for Weight Loss Alone
Section 1927(d)(2)(A) of the Social Security Act, as amended by the Medicare Modernization Act of 2003, prohibits Medicare Part D from covering drugs whose primary use is for weight loss or weight gain. This statutory exclusion is why Medicare historically did not cover Wegovy, Ozempic (when used off-label for weight management), or other obesity medications.
The cardiovascular indication created a legal workaround: when Wegovy is prescribed specifically to prevent heart attacks and strokes, it is classified as a cardiovascular drug, not a weight-loss drug, so the exclusion does not apply. Congress would need to pass new legislation to permanently extend Medicare coverage of GLP-1s for obesity without requiring a separate diagnosis.
Alternatives If You Don't Qualify for Part D Wegovy Coverage
If you do not qualify for either the cardiovascular Part D pathway or the GLP-1 Bridge, you have several options to reduce your cost. Wegovy without insurance typically runs $1,349/month at list price:
What Happens After December 31, 2027
The GLP-1 Bridge now runs through December 31, 2027. CMS intends for the BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive Health) to take over beginning in 2027. BALANCE is a voluntary demonstration for Part D plans, which means plan participation is not guaranteed. Beneficiaries who begin Wegovy on the Bridge may need to switch to a Part D plan participating in BALANCE to maintain $50 copay coverage in 2027. CMS has stated it will release details on BALANCE plan participation ahead of the 2027 open enrollment period.
Starting January 1, 2027, Novo Nordisk plans to reduce Wegovy's list price by approximately 50%, bringing it to around $675 per month. The Medicare negotiated price for Wegovy is expected to reach $274 per month in 2027 for beneficiaries covered through standard Part D. These price reductions will improve the economics for any Medicare beneficiaries who continue to pay standard Part D cost-sharing.
Frequently Asked Questions
Does Medicare Part B cover Wegovy?
No. Medicare Part B covers physician-administered drugs, not self-injected medications. Wegovy is a self-administered weekly injection, so it falls under Part D prescription drug coverage, not Part B. Part B does not cover Wegovy under any indication.
Does Medicare cover Wegovy for weight loss without a heart disease diagnosis?
Not through standard Part D, due to the Medicare Modernization Act of 2003 weight-loss drug exclusion. However, starting July 1, 2026, the Medicare GLP-1 Bridge program covers Wegovy for obesity at a $50/month copay for beneficiaries with a BMI of 35 or higher, or BMI of 27 or higher with certain conditions including pre-diabetes. The Bridge runs through December 31, 2027.
What cardiovascular disease qualifies me for Medicare Wegovy coverage?
Established cardiovascular disease means a prior heart attack (myocardial infarction), a prior stroke, or symptomatic peripheral arterial disease. High blood pressure, high cholesterol, and pre-diabetes alone do not qualify under the cardiovascular Part D pathway. You also need a BMI of 27 or higher.
How much does Wegovy cost on Medicare in 2026?
Under the cardiovascular Part D pathway, your cost depends on your plan's formulary and cost-sharing; standard Part D rules apply and those costs count toward the $2,100 annual out-of-pocket cap. Under the GLP-1 Bridge (July 2026 through December 2027), you pay a flat $50 per month, which does NOT count toward your $2,100 cap. Wegovy's 2026 list price is $1,349/month.
Does the Medicare GLP-1 Bridge $50 copay count toward my Part D out-of-pocket cap?
No. The $50 monthly Bridge copay does not count toward your Part D annual deductible or your $2,100 out-of-pocket spending cap. It operates entirely outside the standard Part D benefit structure. Low-income subsidy (Extra Help) does not reduce the Bridge copay either.
Can I use the NovoCare savings card for Wegovy if I have Medicare?
No. Novo Nordisk's NovoCare savings program is explicitly not available to patients enrolled in Medicare, Medicaid, VA, TRICARE, or any other federal or state health care program. If you have Medicare, the GLP-1 Bridge copay or standard Part D cost-sharing are your main cost-reduction tools.
Does Medicare Advantage cover Wegovy?
Some Medicare Advantage plans with drug coverage (MA-PD) include Wegovy on their formulary. Coverage depends on the specific plan. During open enrollment, you can use the Medicare Plan Finder at medicare.gov to search plans that include Wegovy. Plans that participate in the GLP-1 Bridge can also offer it at the $50 Bridge copay.
What happens to my Wegovy coverage after the GLP-1 Bridge ends in December 2027?
CMS plans to transition Bridge participants to the BALANCE Model demonstration starting in 2027. BALANCE plan participation is voluntary, so your current Part D plan may or may not continue the program. During the 2027 open enrollment period (October to December 2026), check whether your plan joins BALANCE; if not, consider switching to a plan that does, or confirm whether you qualify under the cardiovascular Part D coverage path.
