Semaglutide is a prescription medication. Injectable forms of the drug are available under the brand names Ozempic and Wegovy. The pill form of semaglutide is available as the brand-name drug Rybelsus.
Medicare drug plans usually cover Rybelsus when doctors prescribe it for type 2 diabetes.
The Food and Drug Administration (FDA) has approved Rybelsus, the pill form of semaglutide, to lower blood sugar levels when taken along with exercise and diet in people with type 2 diabetes.
If you have a Part D prescription drug plan or a Medicare Advantage (Part C) plan with drug benefits, your plan may cover Rybelsus if your doctor prescribes it for this FDA-approved use.
Every Medicare drug plan has a list of covered drugs called a formulary. Not all Medicare plans may cover Rybelsus. If you’re unsure whether your plan may cover Rybelsus, check its formulary or contact a plan representative.
Some doctors prescribe the pill form of semaglutide off-label to assist with weight loss. “Off-label” use describes taking a drug for a purpose the FDA hasn’t approved.
Medicare doesn’t cover drugs when people take them off-label. For this reason, it doesn’t cover the pill form of semaglutide for weight loss.
Medicare drug plans group covered medications into tiers. Drugs in higher tiers typically carry higher costs. Since Rybelsus is a brand-name drug with no generic alternative, it’s usually a tier 3 or 4 drug.
The exact cost of the pill form of semaglutide may vary based on your specific plan. Part D plans and Medicare Advantage plans have different cost and coverage rules.
If your plan has a deductible, you typically must pay the entire drug cost until you reach your deductible. After that, you may have a copayment or coinsurance.
However, with a Part D plan, you can spend a maximum of $2,000 out of pocket on covered medications in 2025.