Does Medicare cover Wegovy? It depends on why it is prescribed
Medicare covers Wegovy through Part D for heart risk or MASH, through the $50 GLP-1 Bridge for weight management, and not at all for an off-label use.
Medicare coverage of a GLP-1 is decided by the use written on the prescription, not by the drug. Part D cannot pay for drugs used for weight loss: the exclusion comes from the Social Security Act and is restated in the federal definition of a Part D drug. Part D can and does cover the same molecules for other uses on their labels, and CMS lists them in its Bridge guidance: type 2 diabetes, moderate to severe obstructive sleep apnea and noncirrhotic MASH, to which the cardiovascular risk reduction of Wegovy is added. So Wegovy prescribed after a heart attack to a person with overweight is a Part D drug, with your plan’s cost sharing and the $2,100 cap; Wegovy prescribed to lose weight goes through the separate Medicare GLP-1 Bridge at $50 a month, from July 1, 2026 to December 31, 2027, if you meet its criteria. Zepbound follows the same logic with sleep apnea, Ozempic and Mounjaro are covered for diabetes, and Foundayo, approved only for weight management, is covered only through the Bridge.
Which Medicare route your prescription takes
Route
GLP-1 Bridge
| Your cost a month (2026) | $50 |
| Your cost for the year | $600 |
A use not on the label is not a Part D use. Estimate only.
Prices read by Radif Partners · Editorial policy · Method and data
Drug by drug, use by use
| Drug | Covered by Part D when prescribed for | Weight management only |
|---|---|---|
| Wegovy (pen and pill) | Cardiovascular risk with established heart disease; MASH with fibrosis (pen) | Bridge, $50 a month |
| Zepbound | Moderate to severe obstructive sleep apnea with obesity | Bridge, KwikPen only, $50 |
| Foundayo | No other labeled use | Bridge, $50 |
| Ozempic, Ozempic pill, Rybelsus | Type 2 diabetes; cardiovascular or kidney risk in diabetes | Not covered |
| Mounjaro, Trulicity | Type 2 diabetes; cardiovascular risk in diabetes | Not covered |
When Part D pays
For a covered use, the drug goes through your plan like any other: formulary, possible prior authorization, the deductible, then coinsurance or a copay. Under the 2026 standard benefit a year of Wegovy at list price reaches the $2,100 cap in May. In 2027 Medicare pays the negotiated semaglutide price, $274 for 30 days, and the yearly share drops to about $1,347. Plans may require documentation of the qualifying condition, and prescribers have to say which use applies.
When the Bridge pays
For weight management, the Bridge charges $50 a month outside Part D. It requires a prior authorization from the prescriber attesting a starting body-mass index of 35, or lower thresholds with certain conditions, and it excludes anyone whose GLP-1 Part D already covers for diabetes, sleep apnea or MASH. CMS adds a nuance for heart disease: a prescription aimed at cardiovascular risk belongs to Part D, one aimed at weight to the Bridge, even for the same patient. The Bridge page covers the criteria in detail.
When nothing pays
Ozempic or Mounjaro prescribed only for weight loss is off-label for that use. Part D cannot cover it and the Bridge does not include those products, so the cost is the self-pay price: $349 a month for Ozempic and $499 for Mounjaro. Medicare enrollees can still use those programs; the purchase simply stays outside the plan and does not count toward the cap.
Medicare Advantage
A Medicare Advantage plan with drug coverage applies the same Part D rules and is an eligible plan type for the Bridge. Some plans offer extra benefits, but none can turn weight loss into a covered Part D use.
Questions to ask before the first fill
Three questions settle most cases. First, what use will the prescriber write: diabetes, heart risk, sleep apnea, MASH or weight management? That single line decides between your Part D plan and the Bridge. Second, is the drug on your plan’s formulary for that use, and does the plan require a prior authorization or a step through another drug first? The plan’s drug list and its member services answer that; the Medicare Plan Finder shows formularies when you compare plans. Third, for the Bridge, does your starting body-mass index and diagnosis meet one of the three CMS thresholds? Your prescriber attests it on the prior authorization form, under penalty of perjury.
The answers also tell you which price applies if you are turned down. A denied Part D claim leaves the self-pay price; a denied Bridge authorization does too. Self-pay purchases do not count toward the yearly Part D cap, so if you also take other expensive covered drugs, appealing a denial can be worth more than paying cash.
Appeals and exceptions
A Part D plan that refuses a drug for a covered use must give you a written notice, and you can ask for a coverage determination and then an appeal; a formulary exception can be requested when the prescriber shows the alternatives are not suitable. The Bridge has its own process through its central processor, with a decision mailed to you within 72 hours of a complete request. None of these routes can turn weight-loss use into a Part D benefit, because the exclusion is in the law itself.