0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]
semaglutide
RxCUI: 2553603
What the CMS Formulary Data Shows for 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]
Per the CMS 2026 Part D formulary file, 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] (RxNorm concept RXCUI 2553603, generic name semaglutide) appears on 20 distinct formulary files spanning 44 Medicare Part D plan offerings - 0.9% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.7.
Real-world access to 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 95% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 47 Part D beneficiaries filled 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] in 2023, with total plan-and-beneficiary spending of $199,774 and an average per-beneficiary annual cost of $4,250.50. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] today.
Coverage Details
- Formularies covering
- 20
- Plans covering
- 44
- Coverage rate
- 0.9%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 95% of formularies
2023 Medicare Spending
- Beneficiaries
- 47
- Total spending
- $199,774
- Avg per beneficiary
- $4,250.50
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]
44 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | Yes | $0 | CA |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | Yes | $0 | CA |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T3 | Yes | $0 | PR |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $49.40 | FL |
| Fallon Medicare Plus Orange (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $0 | MA |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
| Independent Health's Assure Advantage (HMO C-SNP) | INDEPENDENT HEALTH ASSOCIATION, INC. | T5 | Yes | $46.50 | NY |
| Fallon Medicare Plus Green (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $56.40 | MA |
| Independent Health's Medicare Family Choice (HMO I-SNP) | INDEPENDENT HEALTH ASSOCIATION, INC. | T5 | Yes | $58.80 | NY |
| Fallon Medicare Plus Blue (HMO) | FALLON COMMUNITY HEALTH PLAN | T5 | Yes | $72.10 | MA |
| Independent Health's Encompass 65 RED 043 (HMO) | INDEPENDENT HEALTH ASSOCIATION, INC. | T5 | Yes | $190.00 | NY |
Frequently Asked Questions
Is 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] covered by Medicare Part D?
Yes, 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] is covered by 44 Medicare Part D plans (0.9% of all Part D formularies).
What tier is 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] on Medicare Part D plans?
0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] averages Tier 3.7 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] require prior authorization?
100% of Part D formularies require prior authorization for 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]. Step therapy: 0%. Quantity limits: 95%.
How much does Medicare spend on 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]?
In 2023, total Medicare Part D spending on 0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy] was $199,774, covering 47 beneficiaries. The average spend per beneficiary was $4,250.50.
Read our methodology - how this data is sourced, computed, and verified.