Speak with a Licensed Insurance Agent

Search
Close this search box.

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. Recently, for the first time ever, Medicare will cover the drug as a weight loss solution for Medicare Part D enrollees.  Estimated Read Time: 7 mins

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

  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. Does Medicare Cover Wegovy for Diabetes?
  6. Wegovy Covered by Medicare Supplement Plans
  7. How To Get Medicare To Pay For Wegovy

As of recently, Medicare Part D plans will be able to list Wegovy as a covered drug on their formularies.

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.

Medicare has several different parts that play a role in your overall health coverage. 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 holds for beneficiaries seeking Wegovy coverage.

Is Wegovy Covered by Medicare?

According to new communication issued in late March 2024 from the Centers for Medicare and Medicaid Services, Medicare Part D plans may now cover Wegovy when prescribed to prevent heart attacks and strokes in obese patients. In clinical trials, Wegovy was found to reduce the risk of cardiovascular events by 20% in obese patients over the age of 60.

Wegovy is a GLP-1 agonist. This means the drug impacts your hormones and brain to drastically reduce your appetite, thus causing weight loss.

However, Medicare is prohibited from covering weight-loss medications. Because of this, Medicare Part D enrollees have had to pay out of pocket for the drug in the past, regardless of the use. Since the FDA expanded the use case of Wegovy to prevent heart attacks and strokes based on the clinical trials, CMS has been inclined to cover the drug.

“This is a monumental coverage decision for Medicare.” Says Ashlee Zareczny, Compliance manager at Elite Insurance Partners. “I am excited to see thousands of Medicare enrollees be able to receive coverage for this potentially life-saving medication.”

Does Medicare Cover Wegovy for Weight Loss?

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

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

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.Wegovy is now covered by Medicare Part D when prescribed for specific reasons. With this in mind, here are a few considerations you’ll 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.
  • For Medicare to cover Wegovy, it must be deemed medically necessary by your healthcare provider.

Wegovy Coupon for Medicare

If you use Medicare Part D to cover Wegovy, there are no additional coupons you can use to reduce your out-of-pocket costs. However, if you are enrolled in a Medicare Part D plan that does not include Wegovy on its formulary, there may be manufacturers coupons you can use to reduce your cost of the drug outside of Medicare.

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 only covered by Medicare to prevent cardiovascular events.

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.

Wegovy coverage through Medicare falls under Part D. However, there are situations in which Medicare Part B may cover the cost of drugs when receiving the medication in an outpatient setting.

How To Get Medicare To Pay For Wegovy

If your doctor has prescribed Wegovy for cardiovascular preventative care, you may be eligible for coverage through Medicare Part D. Let us help you find a plan that covers the popular drug! Complete our <a href=”/compare-rates/”>online rate form</a> to compare plans in your area or speak with a licensed agent today!

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Addressing Obesity in Aging Patients, NIH. Accessed August 2023.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724972/
  2. MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003, Congress. Accessed August 2023.
    https://www.congress.gov/108/plaws/publ173/PLAW-108publ173.pdf
  3. What Could New Anti-Obesity Drugs Mean for Medicare?, KFF. Accessed August 2023.
    https://www.kff.org/policy-watch/what-could-new-anti-obesity-drugs-mean-for-medicare/
  4. Wegovy, GoodRx.. Accessed August 2023.
    https://www.goodrx.com/wegovy
  5. Fraud & Abuse Laws, HHS-OIG. Accessed August 2023.
    https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
  6. Medicare is barred from paying for weight-loss drugs like Wegovy. Lawmakers just took the first step to change that, Dr. Raul Ruiz. Accessed August 2023.
    https://ruiz.house.gov/media-center/in-the-news/medicare-barred-paying-weight-loss-drugs-wegovy-lawmakers-just-took-first
  7. Ozempic, Wegovy maker lobbies Congress to get Medicare to cover its weight loss drugs, NPR. Accessed August 2023.
    https://www.npr.org/2023/08/10/1193106908/ozempic-wegovy-maker-lobbies-congress-to-get-medicare-to-cover-its-weight-loss-d
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

Comment

Your email address will not be published. Required fields are marked *

string(3) "Yes"

5.0 Satisfaction Rating

It’s free and no obligation!

Find the Most Affordable Medicare Plans in your Area

X