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Navigating Medicare for Wegovy®

From enrollment to payments, here’s how Medicare prescription coverage works.

Coverage for Wegovy®

The Centers for Medicare and Medicaid Services (CMS) now covers obesity medicines like Wegovy® when they are approved by the FDA for other medical reasons—for example, to lower the risk of major adverse cardiovascular events (MACE). Talk with your doctor to see if this could be an option for you.

If Wegovy® is not on your plan’s list of covered medicines, you or your doctor can ask your plan for a non‑formulary medical exception so you can still get Wegovy® for non-weight-related conditions.

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Check your coverage

Do you have health insurance? See if your benefits cover you for Wegovy®.

Check coverage
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Select a Part D plan that covers the medication you need

 

You can compare plans at Medicare.gov

Prefer smaller monthly payments?

Enroll in the Medicare Prescription Payment Plan (MPPP). Instead of an annual lump sum, you’ll pay down your prescription each month.

Steps for MPPP enrollment

Step 1 icon

Opt in to MPPP with your Medicare Part D plan (available as a standalone or part of the Medicare Advantage plan).

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Once approved, your prescription will be ready at the pharmacy with no upfront charge.

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You’ll receive a monthly bill that spreads the prescription costs throughout the year.

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Is my Part D plan eligible for MPPP?

You’ll be notified if you qualify:

  • Prior to starting your plan
  • During the plan year
  • At the pharmacy if your prescription cost exceeds $600

Get clear on your costs

Know exactly what you’ll pay out of pocket for your medicine.

2026 Medicare Part D Out-of-Pocket (OOP) Costs*

Phase 1

Deductible

You pay

100%

until you spend $615a

Phase 2

Initial coverage

You pay

25%

until you spend $2,100b

Phase 3

Full coverage

You pay

$0

after you spend $2,100
out of pocketc

You pay Your plan pays

*Prices based on maximum limit set by Medicare.

Need help with prescription costs?

The Medicare Extra Help program provides assistance for people with low income.

2026 Copayment and
Coinsurance Amounts

Medicare Part D

Question mark icon
  Standard of benefita
Deductible Phase $615
Initial Coverage Phase 25%
(max $2,100 OOP cost)
Full Coverage Phase 0%

Extra Help Program

Question mark icon
  Full subsidyb Dual eligibilityc
Deductible Phase $0 $0
Initial Coverage Phase $5.10 Generic
$12.65 Branded		 $1.60 Generic
$4.90 Branded
Full Coverage Phase $0 Generic
$0 Branded		 $0 Generic
$0 Branded
  Full subsidyb
Deductible Phase $0
Initial Coverage Phase $5.10 Generic
$12.65 Branded
Full Coverage Phase $0 Generic
$0 Branded
  Dual eligiblityc
Deductible Phase $0
Initial Coverage Phase $1.60 Generic
$4.90 Branded
Full Coverage Phase $0 Generic
$0 Branded

aPlans may vary.
bTo qualify, patients must have an annual income ≤150% of the federal poverty level, which is ≤$23,475 for single people or ≤$31,725 for married people. Additional resource limits apply.
cEligible for Medicare and Medicaid.

Apply for Medicare Extra Help

Additional cost assistance

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Call Social Security at
1-800-772-1213

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Stop by your local Social Security office

Find Your Local Office
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Check if your state offers assistance

Find Your State Program

Want to keep this info handy?

It’s available to save or print here.

Download Medicare Part D Guide
NovoCare_Wegovy_v03

Important Safety Information for Wegovy®

What is the most important information I should know about Wegovy®?

Wegovy® may cause serious side effects, including:

  • Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer. It is not known if Wegovy® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
  • Do not use Wegovy® if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

What is Wegovy®?

Wegovy® (semaglutide) injection 1.7 mg or 2.4 mg and Wegovy® (semaglutide) tablets 25 mg are prescription medicines used with a reduced calorie diet and increased physical activity to:

  • reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with known heart disease and with either obesity or overweight.
  • help adults with obesity, or some adults with excess weight (overweight) who also have weight-related medical problems to lose weight and keep the weight off.

Wegovy® (semaglutide) injection 1.7 mg or 2.4 mg is used with a reduced-calorie diet and increased physical activity to help children 12 years and older with obesity to lose weight and keep the weight off

Wegovy® contains semaglutide and should not be used with other semaglutide-containing products or other GLP-1 receptor agonist medicines.

It is not known if Wegovy® injection is safe and effective:

  • to reduce the risk of major cardiovascular events (death, heart attack, or stroke) in people under 18 years
  • to help children under 12 years of age lose weight and keep the weight off

It is not known if Wegovy® tablets are safe and effective for use in people under 18 years of age.

Important Safety Information

Do not use Wegovy® if:

  • you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • you have had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy® injection or Wegovy® tablets. See symptoms of serious allergic reaction in “What are the possible side effects of Wegovy®?”

Before using Wegovy®, tell your healthcare provider if you have any other medical conditions, including if you:

  • have or have had problems with your pancreas or kidneys
  • have type 2 diabetes and a history of diabetic retinopathy
  • have or have had depression, suicidal thoughts, or mental health issues
  • are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)
  • are pregnant or plan to become pregnant. Wegovy® may harm your unborn baby. You should stop using Wegovy® 2 months before you plan to become pregnant
  • are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during treatment with Wegovy® tablets. It is not known if Wegovy® when received through an injection passes into your breast milk

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. Wegovy® slows stomach emptying and can affect medicines that need to pass through the stomach quickly.

What are the possible side effects of Wegovy®?

Wegovy® may cause serious side effects, including:

  • inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without nausea or vomiting. Sometimes you may feel the pain from your abdomen to your back
  • gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery. Call your healthcare provider if you have symptoms, such as pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools
  • increased risk of low blood sugar (hypoglycemia), especially those who also take medicines for diabetes such as insulin or sulfonylureas. This can be a serious side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take Wegovy®. Signs and symptoms of low blood sugar may include dizziness or light-headedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, or feeling jittery
  • dehydration leading to kidney problems. Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration. Tell your healthcare provider right away if you have nausea, vomiting, or diarrhea that does not go away
  • severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Wegovy®. Tell your healthcare provider if you have stomach problems that are severe or will not go away
  • serious allergic reactions. Stop using Wegovy® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat
  • change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Wegovy®
  • increased heart rate. Wegovy® can increase your heart rate while you are at rest. Tell your healthcare provider if you feel your heart racing or pounding in your chest and it lasts for several minutes
  • depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you
  • food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Wegovy® may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Wegovy® before you are scheduled to have surgery or other procedures

The most common side effects of Wegovy® may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, low blood sugar in people with type 2 diabetes, gas, stomach flu, heartburn, and runny nose or sore throat.

Please see Prescribing Information and Medication Guide for Wegovy®.

Wegovy® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

 

Please see Prescribing Information and Medication Guide for Wegovy®.

Wegovy® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.