What is the Medicare out-of-pocket cap for Wegovy?

The Inflation Reduction Act established an annual out-of-pocket cap for covered Part D drugs. Once you reach this cap, you pay $0 for covered drugs for the rest of the year. See CMS.gov for the current cap amount.

Can I use a Wegovy savings card with Medicare?

No. Novo Nordisk's savings program and manufacturer copay cards cannot be used by Medicare beneficiaries. Federal law prohibits this to protect the integrity of federal healthcare programs. Getting Wegovy covered under Part D is the primary way to reduce cost.

How Much Does Wegovy Cost With Medicare in 2026?

Q: How much does Wegovy cost with Medicare?

When covered under Medicare Part D (typically for cardiovascular risk reduction or through the GLP-1 Bridge program), most beneficiaries pay a plan copay rather than the full cash price of $1,300+/month. Exact cost depends on your plan's formulary tier and benefit phase. The Part D out-of-pocket cap limits annual spending on covered drugs.

Q: Does Medicare cover Wegovy?

Medicare Part D covers Wegovy for qualifying beneficiaries — primarily those with established cardiovascular disease and obesity, or through the Medicare GLP-1 Bridge program. It is generally not covered for weight loss alone without a qualifying medical condition.

Wegovy's list price tops $1,300 a month — but Medicare beneficiaries who qualify for Part D coverage often pay a fraction of that. Here's what drives your actual cost.

By Alex Carter, Medicare benefits specialist · Published June 28, 2026 · Reviewed June 28, 2026

Wegovy (semaglutide 2.4 mg, made by Novo Nordisk) is one of the most effective weight-loss medications ever approved — and one of the most expensive. For Medicare beneficiaries, the math only works if Part D covers it. This article explains exactly who can get coverage, what the coverage actually costs you out of pocket, and what happens if you don't qualify.

What Wegovy costs without Medicare

Without any insurance coverage, Wegovy's list price is approximately $1,300–$1,400 per month as of mid-2026. Most Medicare beneficiaries cannot sustainably pay this out of pocket — which is why getting Part D coverage matters so much. Manufacturer savings cards are not available to people with Medicare, so Part D is essentially the only affordable path for most beneficiaries.

Does Medicare cover Wegovy?

Medicare Part D covers Wegovy for beneficiaries who meet specific medical criteria. Coverage is not automatic and requires prior authorization. The two main pathways are:

Cardiovascular risk reduction: In 2024, CMS expanded coverage to allow Part D plans to cover semaglutide for weight management in people with established cardiovascular disease and obesity. This applies to Wegovy specifically, given its FDA approval for that indication.
Medicare GLP-1 Bridge program: The broader Bridge program, with a July 1, 2026 implementation date, expands access further for qualifying Medicare beneficiaries. Eligibility depends on your conditions, BMI, and plan. Use our eligibility checker to find out if you qualify.

If your only goal is weight loss and you have no qualifying cardiovascular or other medical condition, most plans will still deny Wegovy under standard Part D rules. Verify the current rules at CMS.gov.

What you actually pay with Part D coverage

When Wegovy is covered under Part D, your out-of-pocket cost depends on three factors: your plan's formulary tier for Wegovy, where you are in the Part D benefit phases, and whether you have reached the annual out-of-pocket cap.

Part D Phase	What you pay
Deductible phase	Full drug cost until deductible is met (varies by plan; some plans have $0 deductible for certain tiers)
Initial coverage phase	Your plan's copay or coinsurance for Wegovy's formulary tier — typically 25–33% or a flat copay
Out-of-pocket cap reached	$0 for covered drugs for the rest of the year

Figures illustrative. See CMS.gov for current cap amount. Verify tier and deductible with your plan.

How the Part D out-of-pocket cap helps

The Inflation Reduction Act established an annual out-of-pocket cap for covered Medicare Part D drugs. Once your total out-of-pocket spending on covered drugs hits this cap in a calendar year, you pay $0 for the rest of the year — including for Wegovy. For beneficiaries taking a high-cost GLP-1, this cap can mean months of free medication after crossing the threshold. The current cap amount is published on CMS.gov.

Use our cost calculator to estimate when you would reach the cap and what your total annual spending would be.

Ways to lower your Wegovy cost under Medicare

Get prior authorization approved. This is step one — without it, you pay full price. Make sure your prescriber submits complete documentation of your qualifying condition.
Choose a plan with a lower tier for Wegovy. During Medicare's Open Enrollment (Oct 15 – Dec 7), compare Part D plans using Medicare's Plan Finder. Formulary tiers and copays vary widely between plans.
Apply for Extra Help (LIS). If your income and assets are limited, the Low Income Subsidy program can dramatically reduce or eliminate your Part D cost-sharing. Apply through the Social Security Administration at ssa.gov.
Appeal a denial. If your PA is denied, don't stop there. A well-documented appeal often succeeds. See our denial appeal guide.
Ask about non-Medicare options. If you are not yet on Medicare or have a gap, see our non-Medicare options page for alternatives.

See if you qualify for Wegovy coverage

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