Does Medicare cover Wegovy in Oregon?

What Wegovy is used for

Wegovy is semaglutide, sold as a weekly injection and as a tablet. Its FDA label covers reducing the risk of major cardiovascular events in adults with established heart disease and obesity or overweight, chronic weight management with diet and exercise, and a form of fatty liver disease (MASH) with moderate to advanced liver scarring in adults.

This page explains Medicare coverage only. Questions about whether Wegovy is right for you belong with your prescriber.

Which part of Medicare covers Wegovy

Wegovy is self-administered, so any Medicare coverage runs through Part D, in one of two ways:

• Your Part D plan can cover Wegovy for a medically accepted use that isn't weight loss alone, such as heart-risk reduction or the liver disease on its label, if Wegovy is on its formulary. Expect prior authorization.
• The Medicare GLP-1 Bridge covers Wegovy (injection or tablet) for weight management when you meet CMS's criteria, outside your plan's formulary.

Is Wegovy on Medicare's negotiated-price list?

CMS selected semaglutide (Wegovy, Ozempic and Rybelsus, as one selected drug) in the second round of the Medicare Drug Price Negotiation Program. CMS says its negotiated price takes effect January 1, 2027. A negotiated price is what Medicare drug plans and pharmacies pay; it isn't your copay. What you pay still depends on your plan's cost sharing. The negotiated price applies when a Part D plan covers Wegovy; it doesn't change the rule against covering weight loss alone.

How the Medicare GLP-1 Bridge works for Wegovy

• Dates: coverage started July 1, 2026, and CMS extended it through December 31, 2027.
• Who qualifies: people with Part D, 18 or older, with a BMI of 35 or more; or 30 or more with diastolic heart failure, uncontrolled high blood pressure or stage 3a or later kidney disease; or 27 or more with prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease. You're not eligible if you have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease, or already get a GLP-1 through your plan.
• How: your prescriber sends the prescription and completes the prior authorization, certifying you're in a diet and exercise program. You pay a flat monthly copay set by CMS.
• Limits: the Bridge copay doesn't count toward your Part D deductible or the $2,400 cap, and Extra Help and the Medicare Prescription Payment Plan can't be used for it.

Check eligibility at Medicare.gov/glp1bridge or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Coverage after 2027 hasn't been decided.

What you pay for Wegovy in 2027: the out-of-pocket cap

Your cost for Wegovy depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Wegovy and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

These cost rules apply when your Part D plan covers Wegovy for a non-weight-loss use. Wegovy through the GLP-1 Bridge has its own copay, which doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Wegovy

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have OHP (Medicaid), a Medicare Savings Program or SSI; otherwise apply through Social Security at 1-800-772-1213 or ssa.gov/extrahelp. See Extra Help in Oregon.

Getting Wegovy covered in Oregon

Oregon and Washington share Part D region 30, so standalone Part D plans are offered region-wide. For 2027, Oregon has 8 standalone Part D plans from 4 companies, plus Medicare Advantage plans with drug coverage in most counties (61 open to everyone statewide). Each plan has its own formulary, so one plan's coverage of Wegovy tells you nothing about another's.

Where you live in Oregon changes your choices. CMS data show no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla or Union counties for 2027 (only employer group plans), and only a special needs plan in Curry County. If you live there, coverage for Wegovy usually comes from a standalone Part D plan alongside Original Medicare, unless you have employer or other drug coverage. Check your county's numbers on Oregon counties.

If you have both Medicare and OHP, OHP doesn't pay for drugs that Part D covers. The Oregon Health Authority calls this "OHP with Limited Drug": you need a Part D plan (or a Medicare Advantage plan with drug coverage) for Wegovy, and you qualify for Extra Help automatically. See OHP and Medicare.

How to check whether a plan covers Wegovy

1. Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Wegovy and not another.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Wegovy and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Wegovy stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Wegovy, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Oregon?

Sources

• National Library of Medicine — DailyMed: Wegovy prescribing information (FDA label)
• Medicare.gov — Medicare GLP-1 Bridge
• CMS — Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• CMS — Part D plan files record layout (PDP Region 30: Oregon, Washington)
• Oregon Health Authority — OHP and Medicare

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