Does Medicare Cover Wegovy?
- Medicare does not cover Wegovy for weight loss. Some private Medicare prescription drug plans may help cover drugs like Ozempic or Mounjaro for treatment of Type 2 diabetes, though few of these plans cover these drugs strictly for weight loss. Learn more about your Medicare and Medicaid options for help losing weight.
Wegovy is a popular weight loss drug that was approved by the FDA in 2021 after performing well during clinical trials. If you’re Medicare beneficiary looking to shed a few pounds, you might be wondering if Wegovy is covered by Medicare.
Original Medicare (Parts A and B) and private Medicare plans such as Medicare Advantage (Part C) plans and Part D prescription drug plans do not typically cover Wegovy. Federal rules prevent Medicare from covering drugs like Wegovy when they’re prescribed solely for the purpose of weight loss. Keep in mind:
- There are other weight loss drugs or weight loss therapies that may be covered by Medicare when prescribed for treating diabetes or other weight-related conditions.
- Wegovy may be covered by some non-Medicare health insurance plans.
- Medicare covers certain other items and services related to weight loss.
Continue reading to learn more about Wegovy, Medicare and weight loss treatments.
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Which Weight Loss Drugs Are Covered by Medicare?
Ozempic and Mounjaro are two drugs designed to lower blood sugar levels and are prescribed for the treatment of Type 2 diabetes. Some Part D plans and Medicare Advantage plans may cover one or both of these drugs for treatment of Type 2 diabetes, but they’re not likely to cover these drugs when prescribed strictly for weight loss.
Neither drug is FDA-approved exclusively as a weight loss drug, but each may assist patients who have Type 2 diabetes in losing weight by helping to lower blood sugar levels. Ozempic and Mounjaro are not intended for use by anyone without diabetes.
In 2023, 94% of Medicare Advantage and Part D prescription drug plans covered Ozempic for treatment of Type 2 diabetes.
Wegovy is an appetite suppressant that is typically only prescribed for the purpose of losing weight. As such, it does not meet the Medicare standards of coverage and is not covered by any part of Medicare.
Medicare Part D prescription drug plans and Medicare Advantage plans that include prescription drug coverage can cover some weight loss drugs, though most of these plans have not extended coverage to drugs like Wegovy.
When Will Medicare Pay for Wegovy?
While Medicare doesn’t currently cover Wegovy, a bill was introduced in the U.S. House of Representatives that would expand Medicare coverage to include weight loss drugs like Wegovy.
The Treat and Reduce Obesity Act of 2023 was introduced in July 2023 but has yet to move forward for a vote.
Is Wegovy Covered by Insurance?
Weight loss drugs like Wegovy may be covered by some health insurance plans offered through employers or those purchased privately or through the federal Marketplace.
Coverage of Wegovy and other weight loss drugs will vary from one insurance company and plan to another, so it’s wise to check with your desired plan or provider to learn whether Wegovy will be covered and how.
Other weight loss drugs that may or may not be covered by health insurance include:
- Orlistat (Xenical)
- Phentermine-topiramate (Qsymia)
- Naltrexone-bupropion (Contrave)
- Liraglutide (Saxenda)
- Setmelanotide (IMCIVREE)
How Can I Get Wegovy Covered by Insurance?
To secure a prescription for Wegovy, you will typically need to have a body mass index (BMI) of 30 or more for an adult or be in the 95th percentile of BMI for children ages 12 and over. Additionally, you will typically need to be diagnosed with a weight-related medical condition such as high cholesterol or high blood pressure.
How Much Does Wegovy Cost Without Insurance?
As of 2023, Wegovy costs $1,349.02 per month.
The list price is the original price of the drug that is set by the manufacturer. The actual amount you might pay for Wegovy can be affected by the pharmacy price, discounts, coupons and your insurance coverage.
Is Wegovy Covered by Medicaid?
Each state determines which prescription drugs will be covered under the state’s Medicaid program.
10 of the states with Medicaid programs that may include some coverage of weight loss drugs include:
- California
- Kansas
- Minnesota
- Wisconsin
- Michigan
- Pennsylvania
- Virginia
- Delaware
- Rhode Island
- New Hampshire
Check with your state Medicaid program to inquire about coverage of Wegovy or other weight loss medications.
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Is There a Generic Form of Wegovy?
There is currently no FDA-approved generic version of Wegovy. The active ingredient in Wegovy is semaglutide, and that ingredient can be found in some off-brand versions of the drug.
The FDA has issued a warning about using these off-brand versions due to concerns over safety and effectiveness.
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