Wegovy Medicare coverage — 2026 guide
Cardiovascular indication only (established CVD + overweight/obesity). Weight-loss-alone use statutorily excluded.
Last verified 2026-06-04. Educational reference only — coverage decisions belong with your benefits administrator and prescriber.
Does the Medicare $2,100 out-of-pocket cap (IRA 2025) apply to Wegovy?
The Inflation Reduction Act caps annual Part D out-of-pocket spending at $2,000 in 2025 and $2,100 in 2026 — but only for drugs that are Part D covered on a beneficiary's plan formulary. For Wegovy:
Partial — depends on indication. Wegovy is excluded from Part D when prescribed for weight loss alone, but CAN be covered (and count toward the $2,100 cap) when prescribed for its non-weight-loss FDA-approved indication.
Sources: Medicare.gov Part D costs · CMS Part D excluded-drug categories
Coverage details
- Part D typical coverage
- statutorily excluded for obesity
- Part B
- Not applicable — GLP-1s are self-administered. Part B does not cover Wegovy.
- Prior authorization
- typically required
- Typical copay (when covered)
- $0–$200/month when covered for the CV indication (varies by plan tier and Extra Help status). Uncovered cash list price ~$1,349/month per Novo Nordisk.
Statutory exclusion explainer
MMA 2003 §1860D-2(e)(2)(A) excludes Part D coverage for drugs "used for anorexia, weight loss, or weight gain". Wegovy for obesity-only remains excluded. CMS clarified March 2024 that Wegovy CAN be covered under Part D when prescribed for the FDA-approved CV indication (reducing major adverse cardiovascular events in adults with established CVD + overweight/obesity).
What to do if Wegovy isn't covered for you
Patient assistance programs
Uninsured? Manufacturer PAPs may ship free product. →
Wegovy manufacturer programs
Copay cards, direct cash programs (NovoCare / LillyDirect). →
Telehealth alternatives
Compare cash-pay GLP-1 telehealth providers. →
Letter of Medical Necessity
Template for prescriber to appeal denial. →
Coverage and copay information should be confirmed with your specific Medicare Part D plan and prescriber before deciding. The information above reflects publicly published CMS and FDA guidance as of 2026-06-04 and does not constitute medical or legal advice.
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