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Medicare Part D
Prescription Drug Coverage 2027
Does Medicare Part D Cover Wegovy in 2027? Heart, Liver and Weight-Loss Rules
Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated November 1, 2026
Medicare Part D plans may cover Wegovy in 2027 when it is prescribed to cut heart attack and stroke risk or to treat the liver disease MASH, but not when weight loss is the only reason. Weight-loss use runs through a separate Medicare GLP-1 Bridge with a $50 monthly copay, which CMS extended through December 31, 2027.
2027 by the Numbers
$385.63
CMS 2027 negotiated price for a carton of four Wegovy 2.4 mg pens (CMS)
$50
monthly copay under the Medicare GLP-1 Bridge for weight-loss use (CMS)
$1,682
yearly cost of Wegovy for heart-risk use under the 2027 standard benefit (our math)
Wegovy is semaglutide, the same ingredient as Ozempic and Rybelsus, approved at higher doses for chronic weight management. Since 2024 it has picked up two more FDA uses that Medicare drug plans are allowed to pay for: lowering the risk of major heart events in adults with heart disease and overweight or obesity, and treating noncirrhotic MASH with moderate to advanced liver scarring.
That means one drug can now reach a Medicare member through two different doors in 2027, with different prices, different rules and very different effects on the $2,400 cap. This page sorts out which door applies. For the diabetes-focused sibling drug, see does Medicare Part D cover Ozempic in 2027.
Key Takeaways
- The reason on the prescription decides whether Wegovy is billed to your Part D plan or to the GLP-1 Bridge.
- Semaglutide’s negotiated prices start January 1, 2027, and they vary by package; the 2.4 mg Wegovy carton is listed at $385.63.
- Bridge copays are a flat $50 but do not count toward the $700 deductible or the $2,400 cap.
- A larger plan-based weight-loss model called BALANCE was delayed and will not start in January 2027.
- Plans that cover Wegovy for heart or liver use usually require prior authorization.
Two Doors: Part D Plan or GLP-1 Bridge
Billed to your Part D plan
✔
Reducing risk of heart attack, stroke or cardiovascular death in adults with established heart disease plus overweight or obesity
✔
Noncirrhotic MASH with stage F2 to F3 fibrosis (injection, accelerated approval)
✔
Plan formulary, tier and prior authorization rules apply
✔
Costs count toward the $2,400 cap
Billed to the GLP-1 Bridge
✔
Weight reduction alongside diet and activity changes
✔
Run by a CMS contractor, not your plan’s pharmacy benefit manager
✔
Flat $50 copay per month
✔
Costs do not count toward the cap
The two doors do not overlap. CMS guidance says a person prescribed Wegovy for a use the basic Part D benefit can cover, such as heart-risk reduction, is not eligible for the Bridge for that prescription, regardless of how the plan lists the drug.
Bridge Eligibility in Plain Terms
| Body mass index (BMI) at start | Extra condition needed |
|---|---|
| 35 or higher | None |
| 30 or higher | Heart failure with preserved ejection fraction, uncontrolled high blood pressure on two medicines, or stage 3a or worse kidney disease |
| 27 or higher | Prediabetes, a past heart attack, a past stroke, or symptomatic peripheral artery disease |
Criteria as published in CMS Bridge FAQs for its 2026 start; you must be 18 or older and enrolled in a Part D plan or Medicare Advantage plan with drug coverage. CMS may revise criteria for 2027.
Extra Help caution: The low-income subsidy does not reduce the $50 Bridge copay, so a person with Extra Help may pay more under the Bridge than for a drug billed to the regular Part D benefit.
Why the Wegovy Price Is Not Just $274
CMS announced a single headline figure of $274 for a 30-day supply of semaglutide starting in 2027. Behind that number, the negotiated price is set for each package and strength. In the CMS listing, a carton of four Wegovy 2.4 mg pens, about four weeks of the top maintenance dose, carries a maximum fair price of $385.63.
$274
headline semaglutide price per 30 days
$385.63
Wegovy 2.4 mg four-pen carton
$959
2024 list price per month, before negotiation
Dose matters for your share. Coinsurance is a percentage of the price for the package you fill, so a higher-strength carton produces a higher bill. The policy side of the negotiation program is covered on our Medicare negotiated drug prices 2027 page.
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Our Cost Math for 2027
| Situation | How 2027 plays out | Yearly total |
|---|---|---|
| Wegovy 2.4 mg for heart-risk use, standard Part D benefit, 12 cartons | $385.63 in January, $332.19 in February, then $96.41 a month | About $1,682 |
| Wegovy for weight loss through the Bridge, 12 months | $50 each month, no deductible | $600 |
| Heart-risk Wegovy plus $600 a month of other brand drugs | $771.41 in January, $246.41 a month through July | Cap of $2,400 reached in August |
Our illustrative math from CMS 2027 parameters ($700 deductible, 25% coinsurance, $2,400 cap) and the CMS-listed carton price. Premiums are extra; real plans may use copays or a lower deductible.
What stands out: The Bridge looks cheaper on paper, but those $600 never move you closer to the cap. For someone who also takes costly brand drugs, Part D spending on a covered use helps reach $0 cost sharing sooner.
What Changed Since the 2026 Plan Year
1
March 2024. FDA approves Wegovy to lower major heart event risk, opening a path to Part D coverage.
2
August 2025. FDA grants accelerated approval for MASH with moderate to advanced fibrosis.
3
December 2025. FDA approves a once-daily Wegovy tablet for weight loss and heart-risk reduction.
4
July 2026. The Medicare GLP-1 Bridge opens for weight-loss prescriptions.
5
January 2027. Semaglutide negotiated prices take effect; the Bridge continues while BALANCE stays on hold.
Whether a plan lists the tablet, the injection or both is a formulary decision, and listings may differ from plan to plan. The carton prices above are for the injection pens, so the tablet’s 2027 price should be checked in the plan’s own drug pricing.
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Getting a Heart or Liver Prescription Approved
Records a plan may ask your prescriber for
✔
Documented heart disease, such as a prior heart attack, stroke or peripheral artery disease
✔
Current BMI showing overweight or obesity
✔
For MASH, liver test or imaging results showing fibrosis stage
✔
The specific FDA-approved use written on the request
If a plan denies the request, your doctor can ask for a coverage determination or exception. New members can usually get a transition fill early in the year while that review happens. Our Medicare Part D formulary 2027 guide covers the exception steps.
Choosing a 2027 Plan With Wegovy in Mind
Compare plans on these points
✔
Whether Wegovy appears on the 2027 formulary at all, since not all plans cover every drug
✔
Which strengths and forms are listed
✔
Tier, copay or coinsurance, and whether the deductible applies
✔
Prior authorization wording for cardiovascular and MASH uses
✔
Your total yearly cost with every other drug included
The cap, deductible and premium for 2027 are explained in our Medicare Part D plans 2027 hub, and the $2,400 limit itself has its own out-of-pocket maximum 2027 page.
The Bottom Line
The Bottom Line
In 2027, Wegovy can be covered by Part D plans for heart-risk reduction and MASH, while weight-loss prescriptions go through the $50 GLP-1 Bridge. The two paths have different prices and only the Part D path counts toward the $2,400 cap. Rules for these programs are still changing, so confirm details with Medicare.gov and your plan.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
Frequently Asked Questions
➤ Can I get Wegovy through Medicare just to lose weight in 2027?
Not through your regular Part D benefit. If you meet the BMI and health criteria, the separate Medicare GLP-1 Bridge can cover Wegovy for weight reduction at $50 a month through December 31, 2027.
➤ Does Wegovy for heart disease count toward the $2,400 cap?
Yes, when your Part D plan covers it for that use. What you pay for a covered Part D drug counts toward the 2027 limit.
➤ What is the negotiated Medicare price for Wegovy?
It depends on the package. CMS lists $385.63 for a four-pen carton of the 2.4 mg dose starting January 1, 2027, while the headline semaglutide figure is $274 per 30 days.
➤ Is the Wegovy pill covered by Medicare Part D?
A plan may list it for heart-risk use, depending on its 2027 formulary. For weight loss, CMS has said the Bridge includes Wegovy tablets.
➤ What happened to the BALANCE weight-loss model?
CMS delayed the Medicare part of BALANCE, so it will not begin in January 2027. The GLP-1 Bridge was extended to fill the gap.
➤ Does the Bridge copay count toward my Part D deductible?
No. Bridge payments are kept outside the standard Part D benefit, so they do not reduce your $700 deductible or move you toward the cap.
➤ Is Wegovy covered for MASH under Part D?
It can be. The FDA granted accelerated approval for noncirrhotic MASH with moderate to advanced fibrosis in 2025, and plans may cover it for that use with prior authorization.
➤ Does Medicare Advantage handle Wegovy differently?
Medicare Advantage plans with drug coverage follow the same Part D rules for heart and liver uses. Bridge eligibility also applies to their members.
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