Wegovy Costs Across Federal Programs, Compared

Last updated 2 weeks ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

Wegovy is a drug for weight management and for reducing cardiovascular risk. What a patient pays for it depends on which federal program covers the prescription and on the reason it was written. Medicare’s regular drug benefit, Part D, does not cover drugs used for weight loss, but a temporary program, the Medicare Bridge, charges eligible patients a $50 copay, a fixed charge, for a month’s supply. In Medicaid, each state may restrict or exclude coverage of a drug used for weight loss.

TrumpRx is the Trump administration’s website for accessing prescription drug discounts. A cash offer on the TrumpRx website for the injection pen starts at $199 a month for a new patient’s first two fills, but that spending earns no credit toward an insurance deductible or out-of-pocket limit. A lower copay in another program is no use to a patient who cannot enroll in it, because each benefit has its own eligibility and coverage rules.

Patient charges and spending credit, compared

A deductible is the amount a patient pays for covered services before the plan starts to pay; many plans pay for certain services before it is met. A formulary is a plan’s list of covered prescription drugs.

Prior authorization is the plan’s advance decision that a prescription is medically necessary; it does not guarantee payment.

For VA and TRICARE, confirm coverage and the exact product’s tier before treating the published tier rate as a Wegovy quote. Active-duty TRICARE members pay nothing for covered drugs at military pharmacies, home delivery or retail network pharmacies. TRICARE’s main rate table does not apply to medically retired sponsors and certain survivors, and it lists $0 home-delivery and retail charges under TRICARE Prime Remote.

Medicare has three different pricing questions

Wegovy is a glucagon-like peptide-1 (GLP-1) drug. Wegovy injections have FDA-labeled weight-management and cardiovascular-risk-reduction uses, with different eligibility conditions. Wegovy tablets have adult weight-management and cardiovascular-risk-reduction indications. A price or coverage rule for one form and use should not be assumed to cover the other.

Ordinary Medicare Part D excludes drugs when used for weight loss, even when obesity is not a cosmetic concern. As an example of a use Part D can cover, the Centers for Medicare & Medicaid Services (CMS) cites Wegovy prescribed to reduce the risk of major cardiovascular events in an adult with established cardiovascular disease and either obesity or overweight. For such a prescription, the Part D plan must follow its existing formulary-exception process, whether or not the drug is on the plan’s formulary.

Standalone Medicare drug plans require Part A or Part B; Medicare Advantage requires both. No Part D plan may have a deductible above $615 in 2026 or $700 in 2027. After out-of-pocket spending on covered drugs reaches the annual limit, the patient enters what Medicare calls catastrophic coverage and owes nothing for covered Part D drugs for the rest of the calendar year. Extra Help assists people with limited income and resources with Part D premiums, deductibles, coinsurance and other costs.

The Medicare GLP-1 Bridge is a short-term CMS program that provides access to certain drugs in Wegovy’s class from July 1, 2026 through December 31, 2027. It operates outside the Part D benefit, but a patient must be enrolled in an eligible Medicare Part D drug plan to use it. It includes Wegovy injection and tablets. Its $50 monthly copay cannot be reduced through Extra Help.

Ask the prescriber to check Bridge eligibility at the start of treatment. To qualify a patient for the Bridge, the provider must attest in a prior authorization request that the drug is prescribed to reduce excess body weight and maintain the reduction, along with ongoing nutrition and physical-activity changes. The qualifying clinical paths are:

• Age 18 or older with a body mass index (BMI) of at least 35 when treatment begins.
• Age 18 or older with BMI of at least 30 and heart failure with preserved ejection fraction, uncontrolled hypertension or chronic kidney disease stage 3a or above.
• Age 18 or older with BMI of at least 27 and prediabetes, a previous heart attack, a previous stroke or symptomatic peripheral artery disease, meaning blocked arteries in the legs or arms with symptoms.

For this program, uncontrolled hypertension means systolic pressure above 140 or diastolic pressure above 90 despite treatment with two blood-pressure medications. A Wegovy prescription written to reduce cardiovascular risk, a use Part D can cover, does not qualify for the Bridge. Meeting one of the BMI paths does not change that; the prescription still goes through the ordinary Part D plan.

Beneficiaries with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) can get these drugs through their Part D plan and are therefore ineligible for the Bridge, even if they otherwise meet its clinical criteria. MASH is a liver disease in which fat buildup causes inflammation and scarring; noncirrhotic refers to disease without cirrhosis, or severe liver scarring. Ask the prescriber to confirm the relevant diagnoses and the prescription’s purpose.

The provider sends the prescription to the pharmacy, completes prior authorization when requested and certifies participation in a diet-and-exercise lifestyle program. Approved authorization covers refills and dose changes through December 31, 2027 unless the patient switches drugs.

Separately, the prices CMS negotiated with drug companies for selected Part D drugs take effect January 1, 2027. CMS lists $274 for a 30-day equivalent supply for the combined Ozempic, Rybelsus and Wegovy grouping. Its package-level example for four Wegovy 2.4 mg/0.75 mL pens is $385.63. Neither figure is a promise that a patient’s pharmacy copay will be that amount. A negotiated drug price, a temporary access benefit and an individual Part D copay answer different questions.

BALANCE is a voluntary model under which CMS will negotiate drug pricing and coverage terms with makers of drugs in Wegovy’s class on behalf of state Medicaid agencies and Medicare Part D plans. CMS says its Medicare component is not launching in 2027; the Bridge has instead been extended through December 31, 2027. That was the status CMS had posted as of September 30, 2026.

Medicaid coverage depends on the state and the medical use

Federal Medicaid rules allow states to restrict or exclude drugs when used for weight loss. California’s Medi-Cal Rx program, for example, stopped covering Wegovy for weight loss alone on January 1, 2026. It still covers Wegovy for noncirrhotic MASH when the prescriber submits a diagnosis code, and it directs patients taking the drug for cardiovascular disease to ask about a prior authorization request. Check your state’s current preferred-drug list and the rules for the diagnosis on the prescription.

For nonpreferred drugs, states may charge up to 20 percent of the drug cost when income exceeds 150 percent of the federal poverty level; at or below that level, copays are limited to nominal amounts. States choose preferred-drug categories and may vary charges by mail-order or retail pharmacy. Those federal limits are ceilings on what a state may charge; they do not set a nationwide Wegovy copay or make an excluded prescription covered.

Low-income families, qualified pregnant women and children, and people receiving Supplemental Security Income are examples of mandatory Medicaid eligibility groups; states can cover additional groups. The state Medicaid agency handles applications, eligibility questions, claims and provider contacts.

BALANCE also has a voluntary Medicaid route: state Medicaid agencies can apply to take part and can join the model between May 2026 and January 1, 2027. That state-by-state participation is separate from the unlaunched Medicare component. Ask the state Medicaid agency whether it participates and which coverage and authorization rules apply.

VA and TRICARE separate enrollment from drug approval

VA says qualifying active military, naval or air service without a dishonorable discharge may establish health-care eligibility. Check VA’s eligibility page for the full service and enrollment rules. VA prescriptions must be written or approved by a VA doctor.

VA’s weight-management criteria address both Wegovy injection and oral tablets. They require documented comprehensive lifestyle intervention covering diet, physical activity and behavioral changes, plus BMI of at least 27 with a weight-related comorbidity. A request for an exception to those criteria is decided at the local VA facility under its pharmacy-committee and pharmacy-service policies.

VA’s active-product copay list places weight-loss semaglutide pen and tablet products in tier 3. A tier listing is not an approval, so ask the VA pharmacy to verify the exact product’s current National Formulary status and criteria. Priority group 1 veterans owe no medication copay. Veterans in priority groups 2 through 8 may owe copays for prescriptions treating non-service-connected conditions, meaning conditions unrelated to military service.

A Federal Supply Schedule price is a negotiated purchasing-contract price available to eligible federal agencies. VA’s Contract Catalog Search Tool lists contract pricing and ordering information. A contract price is what a federal agency pays, not a veteran’s pharmacy bill, and this comparison does not include one for Wegovy.

TRICARE eligibility is decided by the uniformed service of the sponsor, meaning the active-duty, retired, National Guard or Reserve member, and reported in the Defense Enrollment Eligibility Reporting System (DEERS). Spouses and children must be registered in DEERS. For weight management, TRICARE lists coverage under Prime, Prime Remote, US Family Health Plan, Select, Young Adult, Reserve Select, Retired Reserve and the Continued Health Care Benefit Program. It requires clinical eligibility, a network-provider prescription and prior authorization.

TRICARE excludes weight-loss drugs for TRICARE For Life and direct-care-only beneficiaries and certain other groups, even with an approved prior authorization. Use the current TRICARE Formulary Search for the exact form, dose, tier and authorization forms; ask the pharmacy to confirm the final bill. The plan, beneficiary group and pharmacy type determine whether a deductible applies before prescription copays or cost sharing. Payments for noncovered services do not count toward TRICARE’s catastrophic cap.

FEHB and Marketplace plans require a plan-specific check

Eligible federal employees and family members can enroll in FEHB unless the employee’s position is excluded; continuing coverage in retirement has separate requirements. In Carrier Letter 2024-05, the Office of Personnel Management (OPM) told FEHB carriers they are not allowed to exclude anti-obesity medications from coverage as a category. The letter says each carrier must cover at least one weight-loss drug from Wegovy’s class and at least two additional oral anti-obesity options. For 2026, OPM says carriers must continue covering at least one drug from Wegovy’s class and two oral anti-obesity options, plus behavioral and nutritional programs. That class requirement does not guarantee Wegovy on every FEHB formulary.

OPM’s 2027 carrier guidance says anti-obesity medications must be covered only when used alongside intensive behavioral therapy. OPM requires carriers’ drug cost calculators to show pricing, utilization-management restrictions, deductible and out-of-pocket accumulators (credited spending), supply limits and pharmacy-network prices. Choose the actual plan and option, enter the exact Wegovy product and pharmacy, and read the brochure’s prescription section.

For example, the Mail Handlers Benefit Plan (MHBP) Standard Option combines eligible covered network medical and prescription expenses toward a $6,000 Self Only or $12,000 family annual limit. This is an example of a plan’s protection, not a universal FEHB limit or a Wegovy price.

Marketplace enrollment generally requires U.S. residence, citizenship or lawful presence, and no incarceration; people with Medicare cannot enroll in a Marketplace health or dental plan. HealthCare.gov directs enrollees to the insurer’s covered-drug list, Summary of Benefits and Coverage, or insurer contact information to check prescriptions. Check the exact dosage form before selecting a plan or filling the prescription.

When a prescription exception is approved, a Marketplace plan generally charges its highest covered-drug copay and counts the payment toward the deductible and/or out-of-pocket limit.

TrumpRx offers cash prices for both pen and pill

The cash prices and eligibility statements in this comparison were checked on September 30, 2026.

The TrumpRx pen coupon requires a valid prescription, self-payment, age 18 or older and U.S. or territory residency; the coupon is presented at the pharmacy. The pen offer’s terms tell patients with Medicare, Medicaid or other government coverage not to seek reimbursement or count the payment toward insurance deductibles or out-of-pocket limits. The $199 introductory pen price applies to two monthly fills at 0.25 mg or 0.5 mg through December 31, 2026. Later fills cost $349 monthly at 0.25, 0.5, 1, 1.7 or 2.4 mg, or $399 at the HD 7.2 mg dose.

The pill offer from the manufacturer, Novo Nordisk, defines a month as a bottle of 30 tablets and prices it by dose. Novo Nordisk reserves the right to modify or cancel the offer. Compare the prescribed dose with the pill amounts in the table rather than assuming the lowest introductory dose price continues at a higher dose.

The manufacturer’s terms on its NovoCare site say government-program enrollees can pay the self-pay price outside insurance. The TrumpRx page for the same pill offer nevertheless says “Government beneficiaries excluded.” Because the two statements conflict, ask the dispensing pharmacy or manufacturer to confirm the terms it will honor before relying on the offer.

The manufacturer does not classify FEHB, Marketplace or state-employee insurance as government health programs for this offer. The cash purchase cannot be submitted for insurance reimbursement or counted toward its deductible or out-of-pocket limit.

Get a coverage decision before choosing cash

Ask the pharmacy for two clearly labeled quotes: the insured charge after any deductible and authorization, and the cash-offer charge for the same form, dose and supply. Ask which payment will be credited to the plan’s annual limit.

An FEHB denial follows the brochure’s disputed-claims route: plan reconsideration first, then OPM review if the member still disagrees. Medicaid’s written notice must explain how to request a fair hearing and the request deadline. Follow the notice rather than assuming every program uses the same appeal period.

For a Marketplace drug exception, the doctor can explain why covered alternatives are ineffective or harmful, or why the allowed quantity will not work. A denied exception can be appealed and reviewed by an independent third party. For Medicare or TRICARE, ask the plan or pharmacy which coverage or authorization process applies to the denial.

For related explainers, browse the GovFacts prescription-drug collection.