Wegovy is a GLP-1 best known for weight management, but Medicare coverage depends on a specific cardiovascular indication. Here is what qualifies in 2026.
When does Medicare cover Wegovy?
Medicare Part D may cover Wegovy (semaglutide) when it is prescribed to reduce the risk of cardiovascular death, heart attack, or stroke in adults who have established cardiovascular disease and are overweight or obese, provided your plan lists it on its formulary. This cardiovascular indication is the route to coverage, because Medicare cannot pay for Wegovy when the sole purpose is weight loss. Plans frequently require prior authorization to verify the diagnosis. To check whether your plan covers Wegovy for your condition, call 1-800-MEDIGAP at 1-800-633-4427 for a free review.
What does Wegovy cost on Medicare in 2026?
When Wegovy is covered for its cardiovascular indication, you pay your plan's formulary tier cost-sharing, which counts toward the 2026 Part D $2,100 annual out-of-pocket cap. After reaching that cap, covered prescriptions cost nothing for the rest of the year. If you do not meet the cardiovascular criteria, Wegovy is generally not covered, and cash prices run many hundreds of dollars monthly. Because plan formularies and prior-authorization rules differ, a free comparison at 1-800-MEDIGAP helps you find the lowest-cost covered option.