Medicare Part D coverage · semaglutide · RxCUI 2730161
semaglutide 1.5 MG Oral Tablet [Wegovy]
Per the CMS 2026 Part D formulary file, semaglutide 1.5 MG Oral Tablet [Wegovy] is covered by 36 Medicare Part D plans (0.7% of enrollable products), averaging Tier 3.8, with prior authorization required on 100% of covering formularies.
- 0.7%
- Plan coverage
- 36
- Plans covering
- T3.8
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for semaglutide 1.5 MG Oral Tablet [Wegovy]
Per the CMS 2026 Part D formulary file, semaglutide 1.5 MG Oral Tablet [Wegovy] (RxNorm concept RXCUI 2730161, generic name semaglutide) appears on 15 distinct formulary files spanning 36 Medicare Part D plan offerings - 0.7% 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 3.8.
Real-world access to semaglutide 1.5 MG Oral Tablet [Wegovy] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,464,468 Part D beneficiaries filled semaglutide 1.5 MG Oral Tablet [Wegovy] in 2023, with total plan-and-beneficiary spending of $9,194,048,435 and an average per-beneficiary annual cost of $6,278.08. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry semaglutide 1.5 MG Oral Tablet [Wegovy] today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 36
- Coverage rate
- 0.7%
- 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
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,464,468
- Total spending
- $9,194,048,435
- Avg per beneficiary
- $6,278.08
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering semaglutide 1.5 MG Oral Tablet [Wegovy]
36 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
Show the next 16 plans
| 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 |
| 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 |
Frequently Asked Questions
Is semaglutide 1.5 MG Oral Tablet [Wegovy] covered by Medicare Part D?
Yes, semaglutide 1.5 MG Oral Tablet [Wegovy] is covered by 36 Medicare Part D plans (0.7% of all Part D formularies).
What tier is semaglutide 1.5 MG Oral Tablet [Wegovy] on Medicare Part D plans?
semaglutide 1.5 MG Oral Tablet [Wegovy] averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does semaglutide 1.5 MG Oral Tablet [Wegovy] require prior authorization?
100% of Part D formularies require prior authorization for semaglutide 1.5 MG Oral Tablet [Wegovy]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on semaglutide 1.5 MG Oral Tablet [Wegovy]?
In 2023, total Medicare Part D spending on semaglutide 1.5 MG Oral Tablet [Wegovy] was $9,194,048,435, covering 1,464,468 beneficiaries. The average spend per beneficiary was $6,278.08.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- etravirine 100 MG Oral Tablet T3.8
- risperidone 37.5 MG Injection T3.8
- lamotrigine 10 MG/ML Oral Suspension [Subvenite] T3.8
- perampanel 4 MG Oral Tablet T3.8
- {7 (sodium oxybate 4500 MG Granules for Oral Suspension [Lumryz]) / 14 (sodium oxybate 6000 MG Granules for Oral Suspension [Lumryz]) / 7 (sodium oxybate 7500 MG Granules for Oral Suspension [Lumryz]) } Pack [Lumryz 28-Day Starter Pack] T3.8
- loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] T3.8
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA