Clover Health

Does Clover Health cover Wegovy?

Quick answer · Weight Loss

Clover Health does not cover it for weight loss on Medicare Advantage.

  • Medicare Advantage: Not covered. Per CMS guidelines, Medicare Part D plans do not currently cover GLP-1 medications prescribed solely for weight management. Note: Starting July 1, 2026, the Medicare GLP-1 Bridge Program will provide Wegovy coverage at a $50 monthly copay for eligible Part D members meeting BMI criteria. Patients should re-verify coverage on or after that date.

Source: Pa policy. How we verify this data →

Check your card for your exact plan →

Wegovy for Weight Loss

What Clover Health requires, by plan type. Open this indication on its own page →

Medicare Advantage

Not covered

Per CMS guidelines, Medicare Part D plans do not currently cover GLP-1 medications prescribed solely for weight management. Note: Starting July 1, 2026, the Medicare GLP-1 Bridge Program will provide Wegovy coverage at a $50 monthly copay for eligible Part D members meeting BMI criteria. Patients should re-verify coverage on or after that date.

Policy note: Wegovy (semaglutide for weight management) is explicitly excluded from coverage under this Medicare Advantage/Part D plan per CMS rules. This policy only covers GLP-1 RAs for T2DM management. Wegovy is not mentioned by name but the explicit exclusion of GLP-1 RAs for sole obesity treatment effectively excludes it for this indication.

source: Pa policy

Why Wegovy requests get denied by Clover Health

Based on what this policy asks for. Fix these before the first submission.

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.

If weight loss isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Clover Health about a formulary exception, and check whether your employer's plan can add the benefit.

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does Clover Health cover Wegovy?
Clover Health does not cover it for weight loss on Medicare Advantage.
What if my plan excludes weight loss medications?
A prior authorization can't override a benefit exclusion; ask the plan about a formulary exception. Wegovy is also available for cash through NovoCare.

Other medications under Clover Health

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Clover Health's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.