Does Medicare Cover Wegovy in 2026? New Rules & Paths

The answer for two years was “Medicare doesn't cover weight-loss drugs.” So 2026 it's just half the tale, and dates are attached to the other half.

In 2026, Wegovy will be covered by Medicare in two ways. Wegovy is now covered for adults with known cardiovascular disease and obesity or overweight, as the FDA approved it for weight loss in January 2024 but also for reducing the risk of a heart attack or stroke, an indication that's not included in the exclusion. The Medicare GLP-1 Bridge pilot will include coverage for weight management (Pill drug or Wegovy injection) starting July 1, 2026, and will place caps on copays of $50 per month per NPR.

Below: how it works on each of the routes, the new $245 pricing, and what to do if you have heart disease or not.

The Cardiovascular Pathway: Covered Today

The March 2024 approval by FDA was the first time a weight-management drug has been shown to lower cardiovascular death, heart attack and stroke in adult patients with cardiovascular disease and obesity or overweight. That indication is used to treat heart disease, which means that CMS did confirm coverage for that indication in Part D plans, and most major plans added it with prior authorization through 2024 and 2025.

Eligibility includes having documented cardiovascular disease (CVD) such as a previous heart attack, stroke, or symptomatic peripheral arterial disease (PAD) and a BMI over 27. This does not apply to prevention-minded beneficiaries who have not had any cardiac event history. Prior authorization requires the cardiac history, BMI documentation and prescriber attestation of indication.

The Weight-Loss Pathway: Bridge Pilot From July 1, 2026

According to Axios, the November 2025 pricing deal between the administration, Novo Nordisk and Eli Lilly will see GLP-1 go into Medicare for $245 per month, and the first-ever weight-management coverage will be included. Following the failure of plans to sign on to the original insurer-led pilot (STAT News), CMS restructured the pilot to the Medicare GLP-1 Bridge, which will run from July 1, 2026, to December 31, 2027.

The Bridge reviews injectable Wegovy, new pill Wegovy, the Zepbound KwikPen and oral Foundayo. Must be enrolled in Part D and have a BMI of 27 or above and have a qualifying health condition like heart disease or prediabetes. Patients currently on Wegovy who met the criteria when they began the therapy can sign up. Copays are limited to $50 per month.

What Wegovy Costs on Medicare in 2026

The $50 cap on beneficiary copay is now applicable to both pathways and applies to the negotiated $245 price of both. The standard Part D arrangements remain in place with up to $615 deductible on some plans, capped copays, and the annual $2,100 out-of-pocket max for heavy users. Those eligible for Extra Help will have to pay a couple dollars per fill.

Prior to July, beneficiaries without cardiovascular disease can opt for Novo Nordisk's self-pay option: a self-pay channel called NovoCare Pharmacy sells Wegovy for $499 per month, while the TrumpRx self-pay channel for semaglutide is listed near $350 as it rolls out.

Action Plan by Situation

If you have a history of heart disease: Do it now for the heart disease indication; no need to wait until July.

When looking for weight-management coverage: Ensure that Part D enrollment is confirmed, have your BMI and the diagnosis that is qualifying you for coverage documented in your visit before July, and have your prescriber ready to submit when the Bridge begins; pilots may have enrollment caps.

If you are already on Wegovy self-pay: Get your starting-weight records as your prescriber will confirm you met the requirements at the time you started the product, and this way you keep your qualification, even after you lose weight.