Why Wegovy Is So Expensive for Medicare Enrollees
- Ken Connolly
- Jul 14
- 6 min read
Updated: Sep 16
Published:7/14/2025 | 6 min read
Key Points:
Medicare Part D currently doesn't cover weight loss medication by law
The FDA allowed Wegovy to be covered by Medicare under certain ciscumstances related to cardiac health
Direct to consumer alternatives are entering the market to try to lower the cost of weight loss medications, but tread carefully
Every other week the brokers here at NJ Life and Health get a call from a client saying:
"I just got prescribed Wegovy by my doctor. I went to the pharmacy, and not only did my insurance not cover it, the pharmacy said if I wanted it, I would have to pay $1,500 out of pocket!"
Unfortunately, Medicare doesn’t cover Wegovy for weight loss at the moment. Hence the hefty price tag.
The disconnect of what doctors are prescribing and what insurance is covering is and what insurance is covering is creating significant confusion for Medicare enrollees.
Let's explore why these medications are so expensive under Medicare and what options might help make them more affordable.
The Rise of Semaglutide: From Diabetes Treatment to Weight Loss Phenomenon
Weight loss medications like Wegovy contain a primary compound called semaglutide (sometimes referred to as GLP-1). While this compound has been researched for decades, it wasn't until 2017 that the prescription became a household name with Novo Nordisk’s release of Ozempic. [12] Eli Lilly created a similar prescription called Mounjaro in 2022, using the compound tirzepatide. [11]
Initially approved specifically for type 2 diabetes management, something unexpected happened – patients began losing weight as a side effect. According to UC Davis Health, "When using Ozempic to treat diabetes, weight loss is a common side effect."[1]
This unexpected benefit caught public attention when celebrities began visibly losing substantial weight, seemingly with the help of prescriptions like Ozempic and Mounjaro. Today.com reports that celebrities like Charles Barkley, Cathy Bates, Jim Gaffigan and others have openly discussed using semaglutide and tirpetizide medications, with many experiencing significant weight loss that attracted public attention.[2]
As we mentioned above, these prescriptions originally were created and are prescribed only for type 2 diabetes. Then, in June 2021, the FDA approved Wegovy (semaglutide) as the first new medication for chronic weight management in adults with obesity or overweight since 2014.[3]
Why Weight Loss Medications Are So Expensive On Medicare
As of right now, Medicare Part D cannot cover weight loss drugs by law. In 2003, Medicare Part D was created by the Medicare Modernization Act. The belief at the time was that most weight loss drugs weren’t safe for many. Original Medicare may cover things like bariatric surgery to treat extreme obesity, but modern weight loss medications are not available to most at the moment.
Even when Ozempic and Monjauro are covered for diabetes, President of NJ Life and Health John O’Hara says it remains expensive: "I've had clients on Medicare Part C & D plans pay $1,500-$1,600 annually for their Ozempic and Monjauro. It can still strain people’s budgets in a big way."
The Cardiac Health Exception: A Potential Coverage Pathway
In 2024, The FDA approved expanded indications for Wegovy to reduce the risk of cardiovascular events in adults with established cardiovascular disease who were obese or overweight.[5] This represents a significant opportunity for coverage, though it requires specific medical documentation.
Ken Connolly adds, "We have seen clients get Wegovy covered because their cardiologist recommended it. It requires prior authorization but is possible in certain cases."
The Options People Are Turning To
For those struggling with the high cost of these medications, several options exist:
1. Novo Nordisk Patient Assistance Program
NJ Life and Health Insurance Group President John O’Hara states, "Novo Nordisk offers a robust patient assistance program for Ozempic for those with incomes up to 400% of the federal poverty level. For a single person, that's $62,600 annually, and for a household of two, it's $84,600. Your doctor must sign the application confirming medical necessity. We’ve had great success with our clients applying for this program"
Novo Nordisk's patient assistance program offers a potential solution for those meeting income requirements. According to the company's official patient assistance information, the program typically provides free medication for up to one year to eligible patients.[6]
However, there's an important limitation: "Unfortunately, as of 2024, Wegovy is not included in the patient assistance program, only Ozempic." Ken says.
2. Direct From the Pharmaceutical Company
To combat the high cost of these medications even with insurance, some pharmaceutical companies are creating new marketing channels to go direct to consumers.
Eli Lilly offers Zepbound, an FDA approved weight-loss medication which contains tirzepatide rather than semaglutide, through its Lilly Direct program. This is a direct-to-consumer program that completely sidesteps insurance.
The FDA approved Zepbound (tirzepatide) in November 2023 for chronic weight management in adults with obesity or overweight with at least one weight-related condition.[7] Zepbound through Lilly Direct represents an alternative that may be more financially accessible.
According to John O’Hara, this direct-to-consumer program can significantly reduce costs: "Through Lilly Direct, Zepbound doses cost between $350-$500 monthly. We’ve run the numbers and instead of paying nearly $18,000 annually for Wegovy, you might pay between $4,000-$6,000 for Zepbound. Remember, all decisions related to your health and the prescriptions you take should be made by a medical professional.”
3. Compounding Pharmacies
Ken says some of his clients are moving off the beaten path to access weight loss medications: " I’ve had people tell me they’re going to compound pharmacies for custom-prepared semaglutide at lower costs. However, these formulations are often not FDA-approved, which presents some risk."
While potentially less expensive, compounded medications carry risks since they don't undergo the same FDA approval process as commercially manufactured drugs. The FDA has issued warnings about compounded prescriptions, noting they do not evaluate the safety, effectiveness, or quality of these products.[8]
4. Direct-to-Consumer Online Services
Several direct-to-consumer telehealth providers like Ro and Hims advertise lower-cost GLP-1 medications.
These telehealth services offer convenience but come with cautions:
"Consider these options at your own risk. These services typically have physicians who prescribe medications based on online consultations. They also spend a fortune on advertising,” Ken warns.
Future Policy Developments
Recent policy efforts have attempted to address the coverage issue.
In November 2024, KFF reported that "The Biden administration has proposed to allow Medicare and require Medicaid to cover drugs used to treat obesity by reinterpreting the statutory language that currently prohibits coverage of drugs used for weight loss under Medicare."[9]
However, these efforts haven't yet succeeded.
The Centers for Medicare & Medicaid Services (CMS) confirmed in the Federal Register that it would not proceed with a proposal to expand Medicare coverage for anti-obesity medications in early 2025, maintaining the current policy at least until 2026.[10]
The Bottom Line: Weighing Options Carefully
The decision about whether to pursue these medications ultimately involves complex financial and health considerations. While the health benefits may be substantial, the cost barriers remain significant for Medicare enrollees.
There doesn’t appear to be any great way for people on Medicare to receive Wegovy at a reasonable cost unless they have cardiac health issues requiring it. The creation of Lilly Direct offers an exciting new option for an FDA-approved option for weight loss, but it is still incredibly expensive. And the market is now rife with non-FDA options that come with significant risk.
As always, consult with your healthcare provider to determine the most appropriate course of action for your specific situation.
Work With Medicare Brokers You Can Trust!
To work with Medicare brokers who understand Medicare and will help you explain it too, talk to NJ Life and Health! Our team of brokers is always ready to talk to you, so call our Toms River, NJ office at 848-226-6897.
Disclaimer: The authors and staff at NJ Life and Health are licensed insurance professionals, not healthcare providers or medical practitioners. This article is intended solely for educational purposes regarding the history of modern weight loss medications, Medicare coverage limitations, and industry efforts to improve affordability. The information provided should not be construed as medical advice. All decisions regarding weight loss medications or any prescription drugs should be made in consultation with your qualified healthcare provider. Medicare coverage information is current as of 5/21/25 but may change. Please verify benefits with your plan before making healthcare decisions.
References
[1] UC Davis Health. (2023, July 19). Ozempic for weight loss: Does it work, and what do experts recommend? Retrieved from https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07
[2] Today.com. (2025, April 2). 24 celebrities who've opened up about taking Ozempic or weight-loss drugs. Retrieved from https://www.today.com/health/celebrities-on-ozempic-rcna129740
[3] U.S. Food and Drug Administration. (2021). FDA Approves New Drug Treatment for Chronic Weight Management. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
[4] Wellcare. (2025). Does Medicare Cover Weight Loss Drugs? Understanding GLP-1 Coverage in 2025. Retrieved from https://www.wellcare.com/en/resources/does-medicare-cover-weight-loss-drugs
[5] U.S. Food and Drug Administration. (2024). FDA Approves Treatment for Cardiovascular Disease Risk Reduction. Retrieved from https://www.fda.gov/news-events/press-announcements
[6] Novo Nordisk. (2024). Patient Assistance Program. Retrieved from https://www.novocare.com/diabetes-overview/let-us-help/pap.html
[7] U.S. Food and Drug Administration. (2023). FDA Approves New Medication for Chronic Weight Management. Retrieved from https://www.fda.gov/news-events/press-announcements
[8] U.S. Food and Drug Administration. (2024). FDA Warns About Compounded Semaglutide Products. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability
[9] KFF. (2024, November 26). Proposed Coverage of Anti-Obesity Drugs in Medicare and Medicaid Would Expand Access to Millions of People with Obesity. Retrieved from https://www.kff.org/policy-watch/proposed-coverage-of-anti-obesity-drugs-in-medicare-and-medicaid-would-expand-access-to-millions-of-people-with-obesity/
[10] Centers for Medicare & Medicaid Services. (2025). Medicare Program; Contract Year 2026 Policy and Technical Changes. Federal Register. Retrieved from https://www.federalregister.gov
About the Author
Ken Connolly is a licensed life and health insurance broker at NJ Life and Health Insurance Group, LLC.
John O’Hara is president of NJ Life and Health Insurance Group, LLC. They are an independent insurance agency specializing in Medicare and life insurance solutions. Since 2018, the agency has helped thousands of people navigate the complexities of Medicare coverage and find affordable solutions to their healthcare needs.