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Wegovy has gained attention as a powerful weight loss medication, especially for those struggling with obesity.
However, if you're on Medicare or soon will be, you may be wondering: Does Medicare cover Wegovy?
Medicare and Wegovy: The general rule
Medicare has strict guidelines on covering weight loss medications.
Under current law, Medicare does not cover drugs prescribed solely for weight management or obesity treatment.
This means that, for most people, Wegovy would be an out-of-pocket expense, one that can reach as high as $1,349 per month without insurance.
In March 2024, the FDA approved Wegovy for a new use: reducing the risk of life-threatening cardiovascular events in adults who are overweight or obese.
This includes conditions like heart attack and stroke.
Because of this change, Medicare may now cover Wegovy if it is prescribed specifically for cardiovascular risk reduction in qualifying patients.
If you have both obesity (or overweight) and a diagnosed cardiovascular condition, your Medicare-approved doctor may prescribe Wegovy, and Medicare could cover it under these circumstances.
While Medicare does not currently cover Wegovy for general weight loss, that could change.
In November 2024, the Biden istration proposed a rule to allow Medicare and Medicaid to cover weight loss drugs, recognizing obesity as a chronic disease.
The final decision now rests with the incoming Trump istration.
Even if Wegovy isn't covered for your situation, Medicare does provide other weight management options:
- Obesity Behavioral Therapy: Medicare Part B covers counseling for beneficiaries with a BMI of 30 or higher.
- Bariatric Surgery: Medicare may cover procedures like gastric by or gastric banding for those who meet certain medical criteria.
- Medicare Advantage Plans: Some plans (Part C) offer wellness programs, fitness benefits, and for healthy habits.
If you're looking to get Wegovy through Medicare, it won't be covered for weight loss alone.
However, if you have both cardiovascular disease and obesity or overweight, you may qualify for Medicare coverage.
With potential policy changes ahead, expanded access to weight loss drugs could be on the horizon.