Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / weight loss only | Not covered |
| Wegovy for cardiovascular risk reduction (SELECT indication) | Covered with PA |
| Zepbound for obstructive sleep apnea (SURMOUNT-OSA indication) | Covered with PA |
Plan type: Medicare Part D, all plans including Humana, Wellcare, Cigna, Aetna, and UnitedHealthcare Medicare. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
Coverage by indication
A federal statutory exclusion under the Medicare Modernization Act of 2003 prohibits Part D plans from covering drugs used solely for weight loss. This applies across all Part D plans, including standalone drug plans and Medicare Advantage drug plans.
Source: Wellcare, Does Medicare Cover Weight-Loss Drugs? (confirms the Part D statutory exclusion for weight loss). Official payer member resource confirming the statutory rule. Verified June 12, 2026.
Wegovy for cardiovascular risk reduction is a non-obesity indication covered under Part D, following the SELECT trial label expansion approved in March 2024.
| BMI threshold | BMI 27 or higher with established cardiovascular disease |
What the prior authorization needs:
- Wegovy must appear on the specific plan's drug list
- Prior authorization with established cardiovascular disease documentation
Source: Wellcare, Does Medicare Cover Weight-Loss Drugs? Understanding GLP-1 Coverage in 2026. Official payer member resource page (HTML, fetched directly). Verified June 12, 2026.
Zepbound for moderate-to-severe obstructive sleep apnea is covered under Part D, following the SURMOUNT-OSA label approved in December 2024. It is not covered for obesity alone.
| BMI threshold | BMI 30 or higher |
| Sleep study (AHI) | Moderate to severe OSA, AHI 15 or higher per SURMOUNT-OSA criteria |
What the prior authorization needs:
- Zepbound must appear on the specific plan's drug list
- Prior authorization with OSA diagnosis documentation
Source: Wellcare, Does Medicare Cover Weight-Loss Drugs? Understanding GLP-1 Coverage in 2026. Official payer member resource page (HTML, fetched directly). Verified June 12, 2026.
Coming in 2026: A July 2026 CMS demonstration, the BALANCE Model or Medicare GLP-1 Bridge, will create a $50 per month pathway for Wegovy, Zepbound, and Foundayo for weight management for eligible Part D beneficiaries. This is a voluntary CMS demonstration, not standard Part D coverage.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list, then have your prescriber submit it.
- Start with the Medicare Part D prior-authorization letter template, which cites this plan's policy and the diagnosis codes a reviewer looks for. Pick the indication that matches your clinical picture.
- Read the full coverage picture, denial reasons, and the four appeal pathways at GLP-1 insurance coverage.
- If your plan does not cover the indication you need, compare cash-pay options in the cost guide and the cheapest legitimate programs.
Frequently asked questions
Does Medicare Part D cover Wegovy and Zepbound?
It depends on the indication. Medicare Part D cannot cover any GLP-1 prescribed only for weight loss, under a 2003 federal statute. It does cover Wegovy for cardiovascular risk reduction and Zepbound for moderate-to-severe sleep apnea, because those are non-obesity indications. This reflects the published policy verified June 2026.
What does Medicare Part D require to approve Wegovy and Zepbound?
For wegovy for cardiovascular risk reduction (SELECT indication): The BMI requirement is BMI 27 or higher with established cardiovascular disease.
Is Wegovy and Zepbound covered for weight loss under Medicare Part D?
Coverage depends on the indication. Weight loss alone may be excluded while a related medical indication is covered. Each indication and its rule are listed above with the source.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Each page is built from a published payer policy document, government statute, or independent formulary analysis (KFF). Every indication row carries the source URL and the date we verified it. Where a payer's policy PDF was confirmed at its public URL but served as an unreadable binary, the policy number and coverage framework were cross-checked against secondary sources and the row is marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit, so those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
