Medicare Coverage Status for Ozempic and Wegovy
Medicare Part D plans may cover Ozempic (semaglutide) when prescribed for type 2 diabetes, but coverage for Wegovy (semaglutide) for weight management is often limited or excluded. Both drugs are manufactured by Novo Nordisk, and their placement on Medicare Part D formularies depends on the plan's pharmacy benefit manager and negotiated contracts. Many plans require prior authorization, step therapy, or quantity limits before approving coverage, and some plans classify Wegovy as non-preferred or exclude it from the formulary entirely. For the latest formulary details, check the official Medicare Plan Finder at Medicare.gov Plan Finder.
As of 2025, Medicare Advantage (Part C) plans also vary widely in their coverage of Ozempic and Wegovy. Some Medicare Advantage plans cover Ozempic for diabetes with standard Part D cost-sharing, while others may restrict Wegovy coverage to members with a BMI of 30 or higher or require documentation of weight-related comorbidities. The Centers for Medicare & Medicaid Services (CMS) does not mandate coverage of weight-management drugs under Part D, leaving coverage decisions to individual plan sponsors. Beneficiaries should verify coverage directly with their plan or use the CMS Plan Finder tool at CMS.gov Plan Finder.
Costs, Prior Authorization, and Access Requirements
Out-of-pocket costs for Ozempic and Wegovy under Medicare Part D depend on the plan's tier placement, deductible, and coverage phase. Brand-name drugs like Ozempic and Wegovy typically fall under a higher cost-sharing tier, with copays or coinsurance ranging from $0 to several hundred dollars per month before reaching the catastrophic coverage threshold. Many plans require prior authorization, which means the prescribing provider must submit clinical documentation showing the patient has tried and failed other diabetes or weight-management treatments. For detailed cost estimates, use the official Medicare Drug Cost Calculator at Medicare.gov Part D Costs.
Prior authorization requirements for Ozempic and Wegovy often include proof of a diagnosis of type 2 diabetes for Ozempic or a BMI of 30 or higher (or 27 with weight-related conditions) for Wegovy. Some Medicare Part D plans require step therapy, meaning the patient must first try and fail a lower-cost alternative such as metformin or another GLP-1 receptor agonist before the plan covers semaglutide. Coverage policies can change annually during the Medicare Open Enrollment period from October 15 to December 7. Beneficiaries should review their plan's Evidence of Coverage document or contact the plan directly to confirm current requirements.
Alternatives, Savings Programs, and Official Resources
If Medicare does not cover Ozempic or Wegovy, patients can explore manufacturer savings programs, Medicare Extra Help (Low-Income Subsidy), and state pharmaceutical assistance programs. Novo Nordisk offers savings cards and patient assistance programs for eligible individuals, but these programs typically cannot be combined with federal healthcare coverage such as Medicare. The Medicare Part D Extra Help program helps lower-income beneficiaries pay for Part D premiums, deductibles, and copays, which can reduce the cost of covered drugs including Ozempic when prescribed for diabetes. Learn more about Extra Help at SSA.gov Extra Help.
For the most current information on Medicare coverage of Ozempic and Wegovy, beneficiaries should consult official resources such as the Medicare website, their state Health Insurance Assistance Program (SHIP), and the CMS coverage determination policies. The 2025 Medicare Part D formulary and drug list