Medicare Part D Coverage for Wegovy
Wegovy (semaglutide) is covered by many Medicare Part D prescription drug plans, but coverage depends on the plan's formulary, pharmacy network, and tier placement. The Centers for Medicare & Medicaid Services (CMS) lists plan-specific formularies on Medicare.gov, where you can search by plan name, drug, and location. You can also use the Medicare Plan Finder tool at Medicare.gov Plan Finder to compare Part D options that include Wegovy.
Most major national insurers such as UnitedHealthcare, CVS Caremark, Express Scripts, and SilverScript include Wegovy on their formularies for 2025, but the drug often falls under a specialty tier with higher copays or coinsurance. Some plans require prior authorization, step therapy, or quantity limits before they will cover Wegovy. Check your plan's Evidence of Coverage and formulary for exact tier placement, cost-sharing rules, and any restrictions that apply to semaglutide medications.
Wegovy Costs and Copays Under Medicare Part D
Wegovy typically carries a high copay or coinsurance under Medicare Part D because it is classified as a specialty drug. Out-of-pocket costs vary by plan, but many enrollees face copays ranging from $50 to several hundred dollars per month depending on the plan's tier structure and pharmacy benefit design. The Inflation Reduction Act caps annual out-of-pocket prescription drug spending at $2,000 starting in 2025, which can limit total annual costs for Wegovy users on Medicare Part D.
Manufacturer savings programs, copay cards, and Extra Help (Low-Income Subsidy) can reduce Wegovy costs for eligible Medicare beneficiaries. Novo Nordisk offers patient assistance programs that may lower the price for those who qualify, and some Part D plans have preferred pharmacy networks that offer lower copays when you use in-network pharmacies. Always confirm coverage and cost details with your plan or a licensed insurance broker before filling a Wegovy prescription.
How to Check If Your Medicare Part D Plan Covers Wegovy
Step-by-Step Formulary Search
To verify coverage, go to Medicare.gov and use the Plan Finder or search individual plan formularies by entering "Wegovy" or "semaglutide." Review the drug's tier, any prior authorization requirements, and the pharmacy network where the drug is covered. You can also call your plan directly or check the plan's annual Evidence of Coverage document for the most current formulary details.
Key Questions to Ask Your Plan
Ask whether Wegovy is on the formulary, what tier it is on, whether prior authorization is required, and if there are quantity limits or step therapy requirements. Confirm whether your preferred pharmacy is in-network and whether the plan offers a mail-order option that may reduce costs. If Wegovy is not covered or is too expensive, ask about alternative covered medications or manufacturer assistance programs.