Does Medicare Cover Wegovy?

Summary: Wegovy is a popular weight loss drug that continues to grow in popularity as a viable option for fighting obesity. However, Medicare rules have created roadblocks for beneficiaries to receive access to the drug. If you want Wegovy covered by Medicare, patience is going to be important as pressure mounts on Congress. Estimated Read Time: 7 mins

1. Is Wegovy Covered by Medicare?
2. Does Medicare Cover Wegovy for Weight Loss?
3. Does Medicare Part D Cover Wegovy?
4. Wegovy Coupon for Medicare
5. Medicare Advantage Plans That Cover Wegovy
6. Does Medicare Cover Wegovy for Diabetes?
7. Wegovy Covered by Medicare Supplement Plans
8. The Push To Get Wegovy Covered by Medicare
9. How To Get Medicare To Pay For Wegovy

Wegovy Medicare coverage continues to be an increasingly popular discussion among beneficiaries as the Novo Nordisk drug has been a popular choice for those struggling with obesity.

In those aged 60 years and older, a demographic representing the majority of Medicare beneficiaries, the National Health and Nutrition Examination Surveys has estimated that 37.5% of males and 39.4% of females are obese.

This is a sizable portion of the population and an important health concern for the welfare of the United States. However, getting Wegovy covered by Medicare is a bit more complicated than you might think.

Medicare has several different parts that play a role in your overall health coverage. Original Medicare (Medicare Part A and Part B) are provided by the federal government, whereas Medicare Advantage plans, Medicare Supplement plans, and Medicare Part D Prescription Drug Plans are coverages provided by private insurers.

It’s important to understand each part when exploring the Medicare Wegovy relationship. Below, we’re breaking down the truth behind Wegovy and Medicare and what the future could behold for beneficiaries.

Is Wegovy Covered by Medicare?

As it stands, Wegovy is not covered by Medicare. This brand of semaglutide is marketed and approved as a weight loss drug. Therefore, Medicare is forbidden from covering Wegovy until some changes are made.

This roadblock for Medicare beneficiaries stems from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The law established Medicare Part D but also prohibited the coverage from including weight loss medications.

Because Wegovy is not covered by Medicare, being prescribed the drug will have no impact on your Medicare benefits. Depending on where you live and where you shop, you can pay anywhere between $1,300-$1,700+ for the medication if you don’t have insurance coverage.

Does Medicare Cover Wegovy for Weight Loss?

Wegovy is a brand-name Semaglutide. While Semaglutide has been approved for coverage by Medicare when medically necessary for diabetes through brands like Ozempic, Wegovy is prescribed specifically for weight loss. Therefore, Medicare coverage for Wegovy to assist with weight loss does not exist at this time.

However, Wegovy is not an exception. Medicare is barred from covering any form of weight loss drug.

Does Medicare Part D Cover Wegovy?

Medicare Part D is the part of Medicare that covers prescription drugs at the pharmacy. Thus, Wegovy coverage is not available for the same reasons listed above. Until Wegovy for Medicare patients is approved, the medication will be unavailable. However, should things change, here are a few considerations you’ll still need to be aware of:

• Medicare Part D plans are provided by private carriers and operate with formularies. Each plan has a different formulary, and these lists will differ depending on where you live, the carrier you enroll with, etc. You’ll need to check the formulary before to be sure your medications are covered.
• Should Medicare cover Wegovy in the future, its use for your healthcare will still need to be deemed medically necessary by your healthcare provider for coverage.

Wegovy Coupon for Medicare

Simply put, there are no coupons involving Medicare and Wegovy. While it may seem like this could be related to the lack of coverage by Medicare for Wegovy, it’s actually a bit more complicated than that.

This is because even though you can’t have Medicare pay for Wegovy, the reason coupons are not allowed is to help prevent fraud. The Anti-Kickback Statute does not allow for the use of coupons with Medicare Part D.

Therefore, if you do have a coupon for Wegovy, even if it gets approval in the future, you can’t use it and your Medicare benefits at the same time. Rx coupons are a great option for some, but if you are a Medicare beneficiary, it’s important to understand both sides when weighing all of your options.

While you cannot use it in addition to your Medicare benefits, there are options for Wegovy coupons through their own website or programs like GoodRx. These coupons may be able to lower your monthly cost if you have Medicare benefits and are prescribed the drug.

Medicare Advantage Plans That Cover Wegovy

Medicare Advantage plans cover the same things that Original Medicare covers. Because the federal government doesn’t allow for weight loss medications to receive coverage through Original Medicare, you won’t find Medicare Advantage coverage for Wegovy either.

Similar to Medicare Part D plans, if coverage for Wegovy does become available in the future, you will need to check your plan’s formulary to ensure coverage is available through your specific plan, as all plan options are different.

Does Medicare Cover Wegovy for Diabetes?

The U.S. Food and Drug Administration (FDA) has approved Novo Nordisk’s Semaglutide drug for diabetes under the Ozempic brand, not Wegovy. As it stands, Wegovy is a weight loss drug and cannot be covered by Medicare, even for diabetes.

However, if Semaglutide is your only option for care, Ozempic can receive coverage through Medicare Part D as long as the medication is listed on your plan’s formulary.

Wegovy Covered by Medicare Supplement Plans

Medicare Supplement plans, also called Medigap plans, are there to cover the costs of healthcare expenses that are left over when using Original Medicare. It is supplemental coverage from private carriers but is there to cover expenses related to Medicare-approved services.

For the most part, having Wegovy covered by Medicare will likely fall under Part D if that day arrives. However, there are situations in which Medicare Part B may cover the cost of drugs when receiving the medication in an outpatient setting.

Regardless of any exceptions or possible scenarios, changes in the Wegovy-Medicare relationship will need to come to allow for such coverage. Until then, there are no situations in which Medicare Supplement plans will cover Wegovy.

The Push To Get Wegovy Covered by Medicare

While there isn’t Wegovy Medicare cost coverage available at this time, that doesn’t mean there won’t be in the future. There are several groups looking to get the weight loss drug approved for Medicare coverage as the U.S. continues to fight against obesity.

The increased popularity of GLP-1 agonists, which are weight-loss injections such as Wegovy, is bringing attention to the demand from patients. However, costs are still a concern for lawmakers. But more groups are coming together to highlight the need for such medication in the hopes that change is on the horizon:

• Despite resistance from lawmakers to fund such expensive medication, a change in attitude is occurring. These days, politicians are much more receptive to the idea, even as the accessibility would raise costs for Medicare, as evidenced by the introduction of The Treat and Reduce Obesity Act of 2023.
• Novo Nordisk is actively lobbying lawmakers to make a change. The drug manufacturer has claimed that their medication isn’t just about weight loss but can help with lowering the risk of heart attacks as well.
• Obesity doctors and advocacy groups are also speaking up to spark change.

Pressure continues to mount on Congress, who would have to change the law in order to allow for Wegovy covered by Medicare to become a possibility. For now, weight-loss drugmakers lobby for Medicare coverage, and possible changes are encouraging but remain unfinalized for beneficiaries.

How To Get Medicare To Pay For Wegovy

Whether it’s Original Medicare or coverage from private insurance carriers, there is no way to have coverage for the popular weight loss drug just yet. Wegovy and Medicare continue to have a separate relationship, but the call for change continues.

Should there come a time in which Wegovy, covered by Medicare, becomes a reality, we’ll be sure to update this page. Until then, you’ll have to seek other means of handling the cost of Wegovy, such as another form of health insurance or out of your own pockets.

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