Medicare now covers Wegovy—but only for heart disease patients at risk

Medicare will now cover the weight-loss drug Wegovy—but only for a specific group of patients. The decision follows a recent FDA approval for its use in reducing heart-related risks. Coverage, however, comes with strict conditions and potential extra costs.

In March 2024, the FDA approved Wegovy for people with heart disease who are overweight or obese. The drug, originally designed for weight loss, can now be prescribed to lower the risk of heart attacks and strokes in this high-risk group.

Medicare Part D and Medicare Advantage plans will cover Wegovy under these new guidelines. But the medication remains off-limits for general weight loss due to a 2003 law blocking such coverage. Patients must also get a prescription from a Medicare-approved doctor to qualify. Even with approval, some drug plans may add hurdles. Prior authorisation could be required, or Wegovy might be classified as a specialty medication with higher out-of-pocket costs. The final price for patients will depend on their plan's premiums, deductibles, and copayment rules. Wegovy works by controlling appetite and is approved for adults as well as children over 12. But under Medicare, its use is strictly limited to heart disease prevention—not weight management alone.

The change means some Medicare patients with obesity and heart conditions can now access Wegovy at a reduced cost. However, coverage depends on individual plan rules, and not all beneficiaries will qualify. Those seeking the drug for weight loss alone will still need to pay in full.