Does Medicare Cover Wegovy? Criteria, Copay, How to Appeal
Yes, through the Medicare GLP-1 Bridge: Wegovy costs $50 a month from July 1, 2026 to December 31, 2027 if you meet its BMI rules. Part D alone does not cover weight-loss drugs.
- Medicare GLP-1 Bridge copay
- $50 a month
- Bridge runs
- July 1, 2026 to December 31, 2027
- Wegovy in the Bridge
- Yes
- Part D for weight loss alone
- Not covered
A quick look at Wegovy
Its half-life is about 1 week: after 7 d, half is gone, and after five half-lives (35 d) about 3% is left.
In STEP 1 over 68 weeks, the result was 14.9% of body weight, compared with 2.4% on placebo.
Monthly US dollar prices include the list price and self-pay offers, with each figure taken from the maker's price page.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does Medicare cover Wegovy?
| Medicine | Approved for | Part D covers | In the $50 Bridge |
|---|---|---|---|
| Wegovy | Weight loss, heart risk and MASH liver disease | Heart risk or sleep apnea uses only | Yes |
- Under Part D, weight loss by itself has no coverage
- Part D can cover it for diabetes or cardiovascular disease
- If you have type 2 diabetes, sleep apnea, or fatty liver, coverage may come from your plan
Sources: TrumpRx, NovoCare, CMS, medicare.gov.
The published policy
- Bridge starts: July 1, 2026
- Bridge ends: December 31, 2027
- Copay each month under the Medicare GLP-1 Bridge: $50
- Drugs in the Bridge: Foundayo, Wegovy, Zepbound KwikPen
- Vials and single-dose pens are not included in the Bridge
- Your Part D deductible: No, this does not count toward it
Read medicare.gov for the policy itself.
Sources: humana.com, medicare.gov, CMS.
Prior authorization checklist
- Diagnosis: Your chart shows either the weight diagnosis required by your plan or another approved Wegovy use, such as heart risk or MASH liver disease.
- BMI on its own: BMI 35 or higher, and no other condition is needed
- Alongside BMI 30 or higher, you need CKD 3a+ or uncontrolled blood pressure or heart failure
- For PAD, prediabetes, a prior heart attack or stroke, you need BMI 27 or higher
- Approval requires prior authorization
- Records: Your measured height and weight, weight-related conditions, and the diet and activity program you tried.
- Sender: your prescriber sends the prior authorization, not you.
Source: medicare.gov.
After a denial: the appeal step
| Denial reason | What to send or ask |
|---|---|
| Criteria not met | Have your prescriber resubmit the request with your measured BMI. Ask them to include every weight-related condition in your chart. The threshold is BMI of 35, or 27 if you have a weight-related condition. |
| The drug is not on the plan's list | Request a formulary exception, and find out which GLP-1 your plan would prefer you use. |
- Request a coverage determination from your Part D plan. If the drug is not listed there, ask for an exception instead.
- If the answer is no, request a redetermination from the plan. Your prescriber can send a statement that backs up your request.
- If that does not work, the appeal goes beyond the plan to an independent reviewer.
What changes by state and plan
The same rules apply to Medicare Advantage plans that include drug coverage. Humana, for example, lists a Bridge copay of $50 for each 30-day supply.
Each Part D plan has its own copay tiers and drug lists, which means diabetes-use copays vary by plan.
With Medicare and Medicaid, Medicaid rules in your state apply to you too: Does Medicaid Cover Wegovy? Criteria, Copay, How to Appeal.
Source: humana.com.
Other choices when coverage says no
| Route | Who it is for | What you pay |
|---|---|---|
| NovoCare Pharmacy: Wegovy pill 1.5 mg | Self-pay, no insurance needed | $149 a month |
| TrumpRx listing (pill, starting) | Self-pay only, not with insurance | $149 a month |
Prices checked November 2026. Each price links to the page it came from.
Sources: TrumpRx, NovoCare, CMS, medicare.gov.