Does Medicare cover Wegovy for heart disease?

CMS, on its Medicare GLP-1 Bridge page for Part D plans: "CMS recognizes the overlap between the clinical eligibility criteria for Medicare GLP-1 Bridge and the Part D-covered indication of risk reduction of major adverse cardiovascular events (MACE)." The Bridge prior authorization "does not require the physician to attest that the beneficiary does not have established cardiovascular disease. However, the prior authorization requires the physician to attest that the drug is being prescribed to reduce excess weight and maintain weight reduction. If the drug is being prescribed in order to reduce the risk of major adverse cardiovascular events (regardless of whether the drug is also prescribed in order to reduce excess weight and maintain weight reduction), that prescription should be routed to the Part D plan."

Centers for Medicare & Medicaid Services, Medicare GLP-1 Bridge: information for Part D plans, effective August 2026 · source

CMS memorandum to Part D sponsors dated June 10, 2026: "Part D plan sponsors must continue to provide coverage of GLP-1s for indications that are currently coverable under Medicare Part D, consistent with CY 2026 bids, and must not deny or limit access to GLP-1s in a manner that improperly encourages use of the Medicare GLP-1 Bridge." Beneficiaries prescribed "Wegovy® to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight should continue to receive coverage through Medicare Part D." Plan sponsors are "not required to change existing cost-sharing for GLP-1 drugs to align with the Medicare GLP-1 Bridge $50 co-pay." For these uses the provider "will need to complete the applicable utilization management requirements" through the Part D plan.

Centers for Medicare & Medicaid Services, HPMS memorandum, "Medicare GLP-1 Bridge: Expectations and Frequently Asked Questions for Part D Sponsors", effective June 2026 · source

CMS, March 20, 2024, "Part D Coverage of Anti-Obesity Medications with Medically Accepted Indications": "CMS is clarifying that AOMs that receive FDA approval for an additional medically accepted indication … can be considered a Part D drug for that specific use." A GLP-1 approved "for chronic weight management alone would not be considered a Part D drug," but if it is also approved to treat diabetes or to reduce major cardiovascular events "then it would be considered a Part D drug for those specific uses only." "Part D sponsors may consider using prior authorization for these products to ensure they are being used for a medically accepted indication."

Centers for Medicare & Medicaid Services, HPMS memorandum, effective March 2024 · source

FDA, March 8, 2024: "the U.S. Food and Drug Administration approved a new indication for use for Wegovy (semaglutide) injection to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight."

US Food and Drug Administration, news release, effective March 2024 · source

Wegovy's prescribing information (revised 06/2026) says the injection is indicated "To reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight." The tablets carry the same use: "To reduce the risk of major adverse CV events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight."

Novo Nordisk, Wegovy prescribing information, effective June 2026 · source

NovoCare's Medicare page says Wegovy "is covered through normal Medicare Part D benefits, for eligible patients when prescribed for other FDA-approved uses, including 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". It adds: "Select a Part D plan that covers the medication you need".

Novo Nordisk, NovoCare: Navigating Medicare for Wegovy · source

Novo Nordisk's Wegovy heart-risk site says Medicare "may pay for Wegovy" "if you have had a heart attack, stroke, or PAD, and obesity or overweight." It tells readers to "Talk to someone at your Medicare plan to find out:" whether the plan pays, "How much they pay", and "If there are any forms to fill out before you can get your Wegovy", and to "ask about the Medicare Prescription Payment Plan".

Novo Nordisk, Wegovy for cardiovascular risk · source

Medicare.gov, drug plan rules: "Plans may also use prior authorization when they only cover a drug for certain medical conditions, but not others." "You or your prescriber can contact your plan to ask for an exception to prior authorization." The prescriber "must provide a supporting statement" for an exception.

Centers for Medicare & Medicaid Services, Medicare.gov: Drug plan rules · source

Medicare.gov: "No Medicare drug plan may have a deductible more than $615 in 2026 ($700 in 2027)." After the deductible you pay "25% of the cost as coinsurance for your generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027)". In the catastrophic stage you pay nothing out of pocket "for covered Part D drugs for the rest of the calendar year."

Centers for Medicare & Medicaid Services, Medicare.gov: Costs in the coverage stages · source

CMS: the Bridge gives access "between July 1, 2026, and December 31, 2027." "Eligible beneficiaries will have a $50 copay … the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary's TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries."

Centers for Medicare & Medicaid Services, Medicare GLP-1 Bridge, effective July 2026 · source

Wegovy savings offer terms: "For patients with commercial insurance who have coverage for Wegovy® (semaglutide) tablets 1.5 mg, 4 mg, 9 mg, 25 mg: Pay as little as ("PALA") $25, subject to a maximum savings of $100 per 1-month prescription … $200 per 2-month prescription, or $300 per 3-month prescription." "Patient is not eligible if he/she is enrolled in any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, VA, DOD, TRICARE". "Savings Offer benefits are set at the discretion of Novo Nordisk and may change without notice."

Novo Nordisk, NovoCare: Wegovy Savings Offer terms · source

Medicare.gov, appeals in a Medicare drug plan: "You or your prescriber can ask your plan for a coverage determination or an exception." You can "Call your plan." "If you're asking for an exception, your prescriber must provide a statement explaining the medical reason why the exception should be approved." A first-level appeal must be requested "within 65 days from the date on the initial denial notice sent by your plan."

Centers for Medicare & Medicaid Services, Medicare.gov: Appeals in a Medicare drug plan · source

The Medicaid drug statute lets a state exclude a list of drugs, and the first item is: "The following drugs or classes of drugs, or their medical uses, may be excluded from coverage or otherwise restricted: (A) Agents when used for anorexia, weight loss, or weight gain." The Part D definition borrows the list: a Part D drug "does not include drugs or classes of drugs, or their medical uses, which may be excluded from coverage or otherwise restricted under section 1396r–8(d)(2)".

42 U.S.C. §1396r-8(d)(2)(A) and §1395w-102(e)(2)(A), Legal Information Institute text · source · §1395w-102

Bridge eligibility is attested by your prescriber and needs a BMI of 35 or more; or 30 or more with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or worse; or 27 or more with pre-diabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease.

Centers for Medicare & Medicaid Services, effective August 2026 · source

The Part D clock runs from receipt, and receipt is presumed. A redetermination request "must be filed within 60 calendar days after receipt of the written coverage determination notice," and "The date of receipt of the coverage determination or at-risk determination is presumed to be 5 calendar days after the date of the written coverage determination or at-risk determination, unless there is evidence to the contrary." That presumption is why the government's own consumer page states the window as 65 days from the date on the notice.

42 CFR §423.582(b), Electronic Code of Federal Regulations, effective August 2026 · source