Does Medicare Cover Ozempic in 2027? What You May Pay

Does Medicare Cover Ozempic?

Medicare Part D may cover Ozempic when it is prescribed for a medically accepted indication, such as treating Type 2 diabetes. Coverage is not automatic under every plan.

Your access and cost can depend on:

• Whether Ozempic is included on your plan’s formulary
• The condition for which it is prescribed
• Its formulary tier
• Prior-authorization requirements
• Step-therapy requirements
• Your deductible and coverage phase
• The pharmacy you use

Ozempic is not FDA-approved specifically for weight loss. If it is prescribed only for weight loss, Medicare Part D generally does not cover it.

Rybelsus, an oral semaglutide medication, may also be covered under Part D for a medically accepted indication, subject to the plan’s formulary and coverage rules.

Will Medicare Cover Wegovy?

Wegovy coverage also depends on why it is prescribed.

Wegovy may be coverable under Medicare Part D when prescribed for an indication that qualifies for Part D coverage, such as reducing the risk of major adverse cardiovascular events in certain adults with established cardiovascular disease and overweight or obesity.

When Wegovy is prescribed solely to reduce excess body weight or maintain weight loss, it generally remains excluded from the standard Part D benefit. However, qualifying beneficiaries may be able to obtain it through the separate Medicare GLP-1 Bridge.

A prescription does not guarantee plan approval. Formulary status, prior authorization, and other plan rules may still apply.

The 2027 Medicare-Negotiated Price Is $274

Beginning January 1, 2027, a Medicare-negotiated price—officially called the Maximum Fair Price—will apply to Ozempic, Rybelsus, and Wegovy when furnished as covered Part D drugs to eligible beneficiaries.

CMS grouped the three semaglutide products for negotiation and established a Maximum Fair Price of $274 for a 30-day equivalent supply.

CMS reported that this amount was 71% below the approximately $959 list price used for comparison. Ozempic, Rybelsus, and Wegovy accounted for approximately $14.4 billion in Medicare Part D spending during the period CMS evaluated.

The negotiated price applies beginning January 1, 2027. Details are available through the CMS selected-drug and negotiated-price information.

Why $274 Is Not Necessarily Your Copay

The $274 Maximum Fair Price is not a universal Medicare copayment.

It is the negotiated ceiling price made available for the selected drug under the Medicare Drug Price Negotiation Program. Your cost at the pharmacy will still depend on your plan’s benefit design and your current Part D coverage phase.

Factors that may affect your Ozempic price with Medicare include:

• Whether your plan covers the medication
• Whether the prescription is for a coverable indication
• Your remaining Part D deductible
• The drug’s formulary tier
• Whether your plan charges a copayment or coinsurance
• Prior-authorization or step-therapy requirements
• Whether your pharmacy is preferred by the plan
• Whether you qualify for Extra Help
• How much you have already spent on covered Part D drugs

If your plan uses coinsurance, the negotiated price may help determine the amount on which your share is calculated. However, that does not mean you will automatically pay $274—or any particular percentage of $274.

How the 2027 Part D Deductible and Out-of-Pocket Limit Apply

For 2027, the standard Medicare Part D deductible is $700, although individual plans may charge a lower deductible or apply it differently across formulary tiers.

The annual Part D out-of-pocket limit is $2,400. Once the amount counted toward this limit reaches $2,400, you generally pay $0 for covered Part D prescriptions for the remainder of the calendar year.

Only covered Part D spending that qualifies as true out-of-pocket, or TrOOP, counts toward this limit. Monthly premiums, noncovered medications, and most cash purchases do not count.

Does Medicare Part D Cover Ozempic for Weight Loss?

Medicare Part D generally cannot cover a drug when it is used solely for weight loss.

Because Ozempic is approved for Type 2 diabetes and certain related health-risk indications—not specifically for weight management—using Ozempic only for weight loss generally does not create a coverable Part D claim.

The same drug ingredient can have different Medicare coverage depending on the product and its medically accepted use. This is why it is important for your prescriber and plan to have accurate diagnosis and prior-authorization information.

The Medicare GLP-1 Bridge does not include Ozempic. It covers specified GLP-1 products prescribed for weight management.

What Is the Medicare GLP-1 Bridge?

The Medicare GLP-1 Bridge is a temporary CMS demonstration that provides eligible Part D beneficiaries with access to certain GLP-1 medications for weight management.

The program runs from July 1, 2026, through December 31, 2027.

Eligible beneficiaries pay a $50 copayment for a 28- or 30-day supply. The Bridge operates outside the standard Part D coverage and payment system.

As of August 2026, eligible products include certain formulations of:

• Wegovy
• Zepbound
• Foundayo

The eligible-drug list may change during the demonstration. Ozempic and Rybelsus are not included as Bridge drugs.

Learn more from the official CMS Medicare GLP-1 Bridge page.

Who Qualifies for the $50 GLP-1 Bridge?

The $50 price is not available to every Medicare beneficiary. A healthcare provider must submit a prior-authorization request confirming that the beneficiary meets the program’s requirements.

In general, the beneficiary must be enrolled in an eligible type of Medicare Part D coverage and receive the medication to reduce excess body weight or maintain weight reduction alongside ongoing nutrition and physical-activity changes.

CMS’s clinical criteria include adults who met one of the following conditions when GLP-1 therapy began:

• A body mass index, or BMI, of at least 35
• A BMI of at least 30 with qualifying heart failure, uncontrolled hypertension, or chronic kidney disease
• A BMI of at least 27 with prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease

Additional requirements and exclusions apply.

For example, beneficiaries seeking a GLP-1 for a condition already eligible for Part D coverage—such as Type 2 diabetes, certain cases of obstructive sleep apnea, or qualifying liver disease—generally must seek coverage through their Part D plan rather than through the Bridge.

Similarly, a GLP-1 prescribed to reduce major cardiovascular events should be submitted to the beneficiary’s Part D plan when the use qualifies for Part D coverage.

What Does the $50 Bridge Copayment Include?

An eligible beneficiary approved for the Medicare GLP-1 Bridge pays $50 for each 28- or 30-day supply of an eligible medication.

Because the Bridge operates outside Part D:

• The Part D deductible does not apply to a Bridge prescription.
• The $50 copayment does not count toward the Part D deductible.
• The copayment does not count toward the $2,400 Part D out-of-pocket limit.
• Extra Help does not reduce the $50 Bridge copayment.
• Coupons and other discount programs cannot be used to reduce it.
• The program does not provide 60- or 90-day fills.
• Approval requires prior authorization.

Beneficiaries should confirm eligibility through Medicare and their healthcare provider instead of assuming that a qualifying BMI alone guarantees approval.

What Might Ozempic or Wegovy Cost With Medicare in 2027?

The answer depends on the coverage path.

What to Review Before Choosing a 2027 Part D Plan

If you take or are considering Ozempic, Rybelsus, Wegovy, or another GLP-1 medication, take these steps before selecting 2027 coverage:

1. Confirm the exact medication and formulation. Coverage rules can differ among products containing similar ingredients.
2. Ask why the medication is being prescribed. The diagnosis and medically accepted indication can determine whether Part D coverage is legally available.
3. Check the plan’s 2027 formulary. Confirm the medication’s tier and whether prior authorization or step therapy applies.
4. Review preferred pharmacies. Your cost can vary between pharmacies under the same plan.
5. Estimate your total annual drug cost. Do not compare plans using the monthly premium alone.
6. Ask about Bridge eligibility. If the medication is for weight management, ask your healthcare provider whether you meet the current clinical criteria.
7. Do not change medications solely for insurance coverage. Medication decisions should be made with your licensed healthcare provider.

The official Medicare Plan Finder can help you compare plans once finalized 2027 information becomes available.

Get a Personalized Medicare Part D Comparison

The $274 negotiated price and $50 GLP-1 Bridge copayment apply under different programs. Neither number tells every beneficiary exactly what an Ozempic or Wegovy prescription will cost.

Your actual coverage depends on the medication’s approved or medically accepted use, your eligibility, your plan’s formulary, your pharmacy, and the plan’s cost-sharing requirements.

Lowcountry Insurance Brokers compares the Medicare drug plans it offers using your prescriptions, dosages, preferred pharmacy, and coverage needs.

Or visit our Medicare Part D plans page to learn more.