Wegovy (semaglutide 2.4 mg) is a once-weekly injection approved by the FDA for chronic weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) plus at least one weight-related condition such as hypertension, type 2 diabetes, or high cholesterol. Many people want to know whether their prescription drug plan will help pay for it because the cash price without coverage is often $1,300–$1,400 per month.
Coverage for Wegovy under prescription drug plans varies widely depending on the plan type (commercial, Medicare Part D, Medicaid), the insurance company, the state, and whether the plan places the drug on a preferred formulary tier. Most commercial plans now cover Wegovy when prior authorization criteria are met, but Medicare Part D and many Medicaid programs still exclude it when used only for weight loss.
This article explains which prescription drug plans are most likely to cover Wegovy in 2025, the usual requirements for approval, typical out-of-pocket costs when covered, and practical steps to check and improve coverage chances. Rules change frequently, so always verify your specific plan details directly with your insurer or through Medicare.gov.
Medicare Part D Coverage for Wegovy
Medicare Part D plans do not cover Wegovy when the only approved use is chronic weight management. Federal law still excludes “drugs for obesity or weight loss” from Part D coverage unless the medication treats another covered condition (such as type 2 diabetes). Ozempic (semaglutide at lower doses) is covered for diabetes, but Wegovy is not interchangeable for weight-loss-only prescribing.
Some Medicare Advantage plans with prescription drug coverage (Part C) offer extra benefits like fitness programs or over-the-counter allowances, but none cover Wegovy for obesity alone in 2025. A limited number of voluntary pilot programs in select regions are testing coverage of anti-obesity medications at reduced copays (around $50/month), but these pilots are not nationwide and enrollment is restricted.
Medicare beneficiaries who also have type 2 diabetes may be able to get Wegovy covered off-label if the prescriber documents diabetes as the primary indication. This approach is not guaranteed and depends on the plan’s prior authorization policies.
Commercial Insurance Coverage (Employer & Marketplace Plans)
Most commercial plans now cover Wegovy when prior authorization criteria are met. Typical requirements include:
- BMI ≥30 or ≥27 with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, cardiovascular disease)
- Documentation of previous unsuccessful attempts at diet, exercise, or other weight-loss methods (usually 3–6 months)
- Use as an adjunct to reduced-calorie diet and increased physical activity
Preferred tier placement reduces copays to $25–$100 per month when combined with the manufacturer savings card. Higher tiers may require $200–$500 coinsurance. Step therapy is common—patients must try metformin, phentermine, or other lower-cost options first.
The Wegovy Savings Card from Novo Nordisk lowers copays to as little as $0–$25 per month for commercially insured patients (subject to annual and monthly maximums, usually $225–$500 in savings per fill). The card cannot be used with government programs or if the patient is enrolled in Medicare Part D.
Medicaid Coverage by State
Medicaid coverage for Wegovy varies significantly by state in 2025. Approximately 20–25 states cover Wegovy for chronic weight management when prior authorization criteria are met. The remaining states either exclude weight-loss-only indications or limit coverage to diabetes-related use (Ozempic).
States that cover Wegovy typically require BMI documentation, evidence of failed prior weight-loss attempts, and ongoing monitoring of adherence and outcomes. Copays are usually very low or $0 for Medicaid beneficiaries.
If your state does not cover Wegovy, you may still qualify for Ozempic if you have type 2 diabetes. Check your state Medicaid website or call the member services number listed on your card for the current formulary and prior authorization criteria.
Comparison of Wegovy Coverage by Major Plan Types
| Plan Type | Covers Wegovy for Weight Loss? | Typical Out-of-Pocket Cost When Covered | Prior Authorization Required? |
|---|---|---|---|
| Commercial (employer/marketplace) | Yes (most plans) | $25–$100 with savings card | Yes |
| Medicare Part D | No | Full cash price ($1,300–$1,400) | N/A |
| Medicare pilot programs (limited regions) | Yes (select areas) | ~$50 | Yes |
| Medicaid | Yes in ~20–25 states | $0–$5 | Yes |
| Uninsured / cash pay | N/A | $1,050–$1,400 (branded); $199–$499 (compounded) | N/A |
Commercial plans offer the best chance of affordable coverage with savings cards. Medicare and most Medicaid plans still exclude weight-loss-only use.
Manufacturer Savings and Patient Assistance Programs
Novo Nordisk provides the Wegovy Savings Card for commercially insured patients. Eligible users pay as little as $0–$25 per month (maximum savings $225–$500 per fill depending on the plan year). The card requires activation through the Wegovy website or prescriber and cannot be used with Medicare or Medicaid.
The Novo Nordisk Patient Assistance Program (PAP) offers free Wegovy to uninsured or underinsured patients who meet income guidelines (usually ≤400% of the federal poverty level). Applications require proof of income, denial from other coverage sources, and a valid prescription. Approval can take 2–6 weeks, but once approved the medication ships directly at no cost for 12 months (renewable).
Similar programs exist for tirzepatide through Eli Lilly. These programs do not cover office visits, lab work, or supplies. Patients must still see a licensed prescriber willing to complete the paperwork.
Compounded GLP-1 Alternatives for Uninsured Patients
Compounded semaglutide and tirzepatide from licensed 503B pharmacies offer the lowest out-of-pocket costs for uninsured patients in 2025. Reputable telehealth platforms charge $199–$499 per month (all-inclusive) for doses up to the maximum approved strength. The fee typically covers virtual consultation, prescription, medication vials/syringes, shipping, and messaging support.
Popular providers include Henry Meds, Lavender Sky Health, OrderlyMeds, Eden, Mochi Health, and Sesame Care. Many use 503B outsourcing facilities that follow stricter manufacturing standards. Monthly pricing often remains flat regardless of dose, which benefits patients on higher maintenance strengths.
Compounded versions are not FDA-approved, so quality depends on the pharmacy. Reputable programs provide third-party sterility and potency testing results for each batch. Avoid companies that sell “research peptides” or ship without physician review.
Practical Steps to Check and Improve Coverage
- Log in to your insurance portal or call the number on your card to review the formulary and prior authorization criteria for Wegovy or Zepbound.
- Ask your prescribing doctor to submit a prior authorization request with documentation of BMI, comorbidities, and previous weight-loss attempts.
- If denied, appeal with additional medical records or a letter of medical necessity from your provider.
- Apply for manufacturer patient assistance if uninsured or underinsured.
- Compare compounded telehealth quotes from 3–5 reputable providers if branded coverage is unavailable.
- Use discount cards (GoodRx, SingleCare) for the lowest cash price on branded product if needed.
Safety and Monitoring Considerations
All GLP-1 medications carry similar gastrointestinal side effects (nausea, vomiting, diarrhea, constipation) that are most intense during dose escalation. These usually improve after 4–8 weeks. Rare serious risks include pancreatitis, gallbladder problems, and thyroid tumors (seen in animal studies).
Regular follow-up with your prescriber is essential. Blood work (A1C, kidney function, lipids) is recommended every 3–6 months. Monitor for severe abdominal pain, persistent vomiting, or signs of dehydration.
Weight loss injections are powerful tools but require medical supervision. Never start, stop, or adjust doses without guidance from a licensed provider.
Medicare does not cover weight loss injections like Wegovy or Zepbound when used only for obesity in 2025, though limited pilot programs test coverage in select regions. Commercial plans offer the best chance of affordable access with prior authorization and savings cards. Compounded telehealth options provide the lowest out-of-pocket costs for uninsured patients. Work closely with your doctor and insurance plan to explore every available path to safe, effective treatment.
FAQ
Does Medicare cover Wegovy or Zepbound for weight loss?
No. Medicare Part D excludes coverage for drugs used only for weight loss or obesity under current federal law. Ozempic and Mounjaro are covered when prescribed for type 2 diabetes.
Are there any 2025 pilot programs that cover weight loss injections under Medicare?
Yes. Limited voluntary pilot programs in select regions test coverage of Wegovy and Zepbound at reduced copays (around $50/month). These pilots are not nationwide and enrollment is restricted.
What is the cash price for Wegovy or Zepbound without insurance?
The cash price for a 4-week supply of branded Wegovy or Zepbound is typically $1,300–$1,400 at retail pharmacies in 2025. Discount cards can reduce it to $900–$1,100 per month at participating locations.
Can I get Wegovy or Zepbound free without insurance?
Yes. Manufacturer patient assistance programs from Novo Nordisk and Eli Lilly provide free branded medication to uninsured or underinsured patients who meet income guidelines (usually ≤400% of the federal poverty level). Approval requires financial documentation and takes 2–6 weeks.
Are compounded GLP-1 injections a safe low-cost alternative?
Compounded versions cost $199–$499 per month through telehealth but are not FDA-approved. Choose providers using 503B pharmacies with third-party testing for sterility and potency. Avoid “research peptides” or sources without physician oversight.
What should I do if my plan denies coverage for Wegovy?
Appeal the denial with medical documentation of BMI, comorbidities, and previous weight-loss attempts. Ask your doctor to submit a prior authorization or letter of medical necessity. If denied, explore manufacturer assistance or compounded options.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.