Does Medicare Cover Wegovy or Ozempic?

For twenty years the answer was a flat no for weight loss and a qualified yes for diabetes. In 2026 that changed, but not in the simple way most people expect. Medicare still cannot cover weight-loss drugs under its regular prescription benefit. Instead, CMS built a separate temporary program that sits alongside Part D and charges a flat $50 a month (verified 2026-09-14). That $50 is a program copay for eligible Part D enrollees, not a cash price anyone can walk in and pay.

Here is how the pieces fit together, what you have to do to use them, and the deadlines that make this a moving target.

None of this is medical advice. Whether a GLP-1 is right for you is a decision for you and your healthcare provider.

Why has Medicare never covered weight-loss drugs?

When Congress created the Part D drug benefit, it excluded a short list of drug categories, including “agents when used for anorexia, weight loss, or weight gain.” That exclusion has been in the statute from the beginning and is still in force [1].

The practical effect: a Part D plan can cover semaglutide, but only when it is prescribed for an indication other than obesity. Those covered uses include:

• Type 2 diabetes (Ozempic, Ozempic tablets)
• Reducing the risk of major cardiovascular events in adults with known heart disease and either obesity or overweight (Wegovy) or in adults with type 2 diabetes and known heart disease (Ozempic)
• Slowing chronic kidney disease in adults with type 2 diabetes and CKD (Ozempic injection)

If your prescription is written for one of those, your plan should cover it subject to its formulary, tier and prior authorization rules. If it is written for obesity alone, the statutory exclusion applies.

What is the Medicare GLP-1 Bridge?

The Medicare GLP-1 Bridge is a short-term demonstration CMS launched on July 1, 2026 under Section 402 demonstration authority, the same kind of authority used for other Medicare pilots [2]. It is nationwide, covers all states and territories, and is not something your Part D plan has to opt into. Plans carry no financial risk for it.

Under the Bridge, eligible Part D enrollees can get certain GLP-1 drugs for obesity at a flat $50 copay for a one-month supply [3]. Manufacturers agreed to supply the drugs at a net price of $245 per 30-day supply; pharmacies are reimbursed by CMS and manufacturers pay CMS back the difference between wholesale acquisition cost and the $245 [1].

It was originally supposed to end December 31, 2026. On April 21, 2026 CMS extended it through December 31, 2027 [1][2].

Which drugs does the Bridge cover?

Medicare.gov lists three [3]:

• Foundayo (orforglipron) tablets
• Wegovy (semaglutide) injection or tablets
• Zepbound (tirzepatide) KwikPen only — single-dose vials and single-dose pens are excluded

Notably, Ozempic, Ozempic tablets and Mounjaro are not on the Bridge list. Those remain ordinary Part D drugs for their approved non-obesity indications.

Who is eligible?

You must be 18 or older with Medicare drug coverage, which includes a standalone Part D plan, a Medicare Advantage plan with drug coverage, a Special Needs Plan, an employer or union group waiver plan, or the Limited Income Newly Eligible Transition program [3].

Then you have to meet one of three clinical thresholds when you start therapy [3]:

BMI	Additional condition required
35 or higher	None
30 or higher	Diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher
27 or higher	Prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease

You are not eligible if you already get GLP-1 drugs covered through your Part D plan, or if you have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease. In those cases your plan should be covering the drug already [3].

How do you actually get it?

Your provider sends a prescription for a covered drug to your pharmacy and, when asked, completes a prior authorization form. The provider must also certify that you are using the drug as part of a lifestyle program focused on diet and exercise [3].

Your pharmacy may ask for your Medicare number or the last four digits of your Social Security number to process the claim. You will get a letter in the mail confirming coverage. Once approved, your prior authorization is valid through December 31, 2027, including for refills and dose changes, unless you switch to a different GLP-1 [3].

What the $50 copay does not do

This is the part people get wrong, and it matters financially.

Because the Bridge runs outside the Part D benefit, your $50 a month [3]:

• Does not count toward your Part D deductible
• Does not count toward your out-of-pocket limit, which is $2,100 in 2026 and $2,400 in 2027 [1][4]
• Does not appear on your Part D Explanation of Benefits or your Medicare Summary Notice
• Cannot be reduced by Extra Help, the low-income subsidy program
• Cannot be spread across months using the Medicare Prescription Payment Plan

KFF has flagged the Extra Help exclusion as a real problem: the people most likely to struggle with $50 a month are exactly the low-income beneficiaries who get no subsidy here [1]. Twelve months of Bridge copays comes to $600 that does nothing to move you toward catastrophic coverage on your other drugs.

What about the $274 Medicare negotiated price?

Separately from the Bridge, semaglutide went through Medicare drug price negotiation. On November 25, 2025 CMS announced a maximum fair price of $274 for a 30-day supply of the Ozempic, Rybelsus and Wegovy group, effective January 1, 2027. That is a 71% discount from the $959 list price CMS recorded for 2024 [5].

Package-level prices vary. CMS published $276.78 for a 4 mg/3 mL Ozempic pen and $385.63 for a four-pen box of Wegovy 2.4 mg [5].

Two things to understand:

The negotiated price is not your copay. It is the price Medicare and your plan pay. Your plan still sets your cost sharing based on its tier structure. If your plan puts semaglutide on a high tier with coinsurance, a lower negotiated price does reduce what the coinsurance is calculated from, but you do not simply pay $274.

There is a competing price. The White House most-favored-nation deals with Novo Nordisk and Eli Lilly set a $245 Medicare price for these drugs [6]. Trade reporting indicates CMS has confirmed that, given the terms and timelines of those deals, the MFN prices for covered GLP-1 drugs are expected to supersede the Inflation Reduction Act prices [7]. Watch this one; it is not fully settled in public documents.

Why did the bigger Medicare program fall apart?

CMS originally planned a two-step approach: the Bridge for 2026, then a full five-year Innovation Center model called BALANCE starting January 1, 2027 that would have folded GLP-1 coverage into Part D plans at negotiated prices, with free lifestyle support programs attached [1].

Participation was voluntary for Part D plans, and CMS set a threshold: at least 80% of Part D enrollment had to be in participating plans. Applications were due April 20, 2026. The next day, CMS announced it would not move forward with BALANCE in Medicare for 2027 and would extend the Bridge instead [1].

KFF reported that major Part D plan sponsors were reluctant or unwilling to participate as the model was designed, and that sponsors had insufficient data to estimate what covering obesity drugs would cost them. Estimates of the cost to Medicare of covering obesity drugs under Part D run $25 billion to $35 billion over ten years [1].

The Medicaid half of BALANCE did go forward, rolling out from May 1, 2026.

What happens after 2027?

Nobody knows, and that is the honest answer. KFF put it plainly: there is no clear path forward for GLP-1 coverage in Medicare after 2027 if the Bridge is not extended again and BALANCE is not implemented [1]. That sets up the possibility that people who start a GLP-1 for obesity under the Bridge in 2026 or 2027 lose coverage in 2028.

It is also unclear whether Part D plans could keep covering GLP-1s for obesity even if they wanted to, since the statutory weight-loss exclusion would still be law [1].

If you are considering starting under the Bridge, it is worth asking your provider what the plan would be if coverage ends.

What if you are on Medicare and not eligible for the Bridge?

Medicare.gov itself suggests a few routes [3]:

• Check whether the manufacturer offers help paying for your drug
• Check whether your state offers drug cost assistance
• Compare mail-order pharmacy prices
• Look at the Medicare Prescription Payment Plan for drugs your plan does cover
• Compare prices on TrumpRx.gov

On that last one, Medicare is unusually blunt: TrumpRx and other discount cards are not creditable coverage, and when you use them instead of your Medicare plan, the money does not count toward your deductible or out-of-pocket maximum [3]. Compare the TrumpRx price against what you would pay under your plan before deciding.

One more note: Novo Nordisk tightened its Patient Assistance Program in 2026. Medicare Part D beneficiaries are no longer eligible to receive Ozempic through the PAP, and uninsured applicants must have household income at or below 200% of the federal poverty level.

Sources

1. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge — KFF, 2026-05-11
2. Medicare GLP-1 Bridge — CMS, 2026-07-13
3. Weight loss drugs — Medicare.gov, retrieved 2026-09-14
4. Medicare Part D Out-of-Pocket Limit is $2,100 in 2026 — GoodRx, 2026
5. Negotiated Prices for Initial Price Applicability Year 2027 — CMS, 2025-11-25
6. Fact Sheet: Most-Favored-Nation Pricing — The White House, 2025-11-06
7. CMS announces MFPs for 15 drugs — NCPA, 2025-12-02
8. Coming Soon: CMS to Provide $50 Monthly Access to GLP-1 Medications — CMS, 2026
9. Medicaid Coverage of and Spending on GLP-1s — KFF, 2026-01-16