Many people are curious about a new weight loss drug called Wegovy. Made by the same company as Ozempic, Wegovy is an FDA-approved weekly injection for long-term weight management. Unlike Ozempic, which was developed to manage type 2 diabetes, Wegovy is specifically intended for weight loss.

In general, Medicare does not cover any weight loss drug, which means your Part D prescription drug plan would not pay for Wegovy. There are numerous reasons behind this decision (stay tuned, we’ll go over them below), but there are other ways Medicare can cover weight management.

Key takeaways:

  • Medicare does not cover Wegovy or any other drug for the purpose of losing weight.

  • There are other services that Medicare does cover for weight management like weight-loss counseling and preventative care.

What is Wegovy?

Wegovy is the first weekly injection for weight-loss medication approved by the FDA since 2014. Both Ozempic and Wegovy incorporate the same active ingredient, semaglutide, which helps with both type 2 diabetes and weight management. Semaglutide slows down the rate of your stomach emptying and makes you feel fuller after meals. Here are a few other ways the drug helps with weight loss:

  • decreases cravings for salty and sweet foods

  • counteracts hormones involved with hunger and weight gain

  • targets brain areas involved with appetite control

The weight loss journey can often be mentally and physically exhausting. Medications like Wegovy can help ease the frustration, but they aren’t the only option for weight management. We’ll look into some other alternatives, especially since Medicare doesn’t cover Wegovy. 

Does Medicare cover Wegovy for weight loss?

You may be confused about why Medicare doesn’t cover Wegovy or any drug specifically intended for weight loss. Numerous studies have shown that obesity can contribute to serious health conditions like cardiovascular disease, high blood pressure, and diabetes. If obesity poses such a risk on your health, why wouldn’t Medicare cover drugs for weight loss management? There are a couple factors that answer this question:

  • Medicare currently considers weight loss drugs to be cosmetic. Medicare doesn’t cover any procedure, service, or drug for cosmetic purposes.

  • Medicare doesn’t cover any medications that could be abused or used for another purpose.

  • Lawmakers confirmed Medicare’s regulations on covering obesity treatments in the 1990s, when weight-loss drugs were less effective and more dangerous. 

It’s true that some Medicare laws and regulations are outdated. There are legislations about Medicare coverage that are constantly changing. Medicare may choose to provide better coverage for obesity medication and treatment in the future, but the program doesn’t cover weight loss drugs as of now.

How much does Wegovy cost?

Without insurance, Wegovy is pretty expensive. The weight loss medication is $1,349 per package for a month’s supply. That means Wegovy costs $16,188.24 out of pocket for a full year.

Does private insurance or Medicaid cover Wegovy?

Though rare, some private insurance companies could cover the drug. It’s worth checking whether or not your insurance covers Wegovy if you have health insurance through your employer. Medicaid also covers weight-loss medications in certain states, but they aren’t a mandatory benefit. There’s a chance you could get Wegovy covered with prior authorization with Medicaid, but it’s always a good idea to talk to your insurance for more reassurance.

What does Medicare cover for weight loss?

Losing weight after 60 can be a frustrating and challenging experience. Luckily, Medicare covers some other alternatives for managing weight loss. Medicare pays for:

  • Preventative care: Medicare covers cardiovascular and diabetes screenings if you’re at risk for these diseases.

  • Nutrition counseling: Medicare covers services from a nutrition expert if you have diabetes, chronic kidney disease, or had a kidney transplant in the last 36 months.

  • Weight-loss counseling: Medicare covers weight loss counseling if you have a BMI of 30 or higher. This includes regular screenings and meetings with a healthcare provider to set up plans for weight management plans.

  • Some obesity-related surgical procedures: Though there are strict eligibility requirements, Medicare covers gastric bypass surgery and laparoscopic banding surgery. 

You’re not alone in your weight-loss journey. There are other ways Medicare can provide coverage for your weight management needs. Your plan may even cover more benefits around fitness and nutrition than you realize. Chapter is here to help you understand every aspect of your Medicare insurance and get the coverage you need for your health. Chat with a licensed Medicare Advisor for free and personalized information—call us at 855-900-2427 or schedule a time to talk today.

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