Does HealthSpring Cover Wegovy? Exceptions, Costs, and the $50 Bridge

HealthSpring does not cover Wegovy on its 2026 Medicare formulary when the drug is prescribed for weight loss, in either injectable or oral tablet form.¹ There are three ways a HealthSpring member may still get Wegovy: coverage for a specific cardiovascular use, a formulary exception requested through the plan, or a new federal program that offers Wegovy for $50 a month starting July 1, 2026, independent of what HealthSpring’s formulary says.

Why Wegovy Is Off the Formulary

Federal law bars Medicare Part D from paying for drugs prescribed solely for weight loss or obesity, and that ban applies to every Part D plan, HealthSpring included.² CMS considered allowing Part D coverage of weight-loss drugs but did not finalize that change for 2026, so lifting the exclusion would take an act of Congress.³

Coverage for Cardiovascular Risk Reduction

In March 2024 the FDA approved Wegovy to reduce the risk of cardiovascular death, heart attack, and stroke in adults who have established cardiovascular disease and are also overweight or obese.⁴ That use falls outside the weight-loss exclusion, so CMS allows Part D plans to add Wegovy to their formularies for this purpose.² Plans are not required to add it, and HealthSpring’s published 2026 formulary does not list it, even for the cardiovascular indication.¹

You can still ask. CMS has told Part D sponsors to continue handling coverage determinations and formulary exceptions for uses that fall under the standard Part D benefit, including the cardiovascular indication.⁵ To qualify clinically, a patient generally needs a prior heart attack, stroke, or peripheral arterial disease along with obesity or overweight.⁶ Plans that cover Wegovy this way typically place it on a high specialty tier with prior authorization or step therapy, and out-of-pocket costs on similar plans run from roughly $325 to $430 per month.⁷

Wegovy for $50 a Month Through the Medicare GLP-1 Bridge

For weight-loss use, the Medicare GLP-1 Bridge is the practical path. Beginning July 1, 2026, this federal demonstration provides Wegovy, Zepbound, and Foundayo at a flat $50 monthly copayment through at least December 31, 2027.⁸ The Bridge runs outside standard Part D, so HealthSpring does not need to opt in; any eligible Medicare beneficiary with Part D drug coverage can use it.⁹

Who Qualifies

All of the following must apply:¹⁰

You are enrolled in a standalone Part D plan or a Medicare Advantage plan with drug coverage. Members of private fee-for-service plans, cost contract plans, or PACE organizations are ineligible unless they also have a standalone PDP.
Your current Part D plan does not already cover the GLP-1 drug you want. If HealthSpring approves Wegovy for you (for example, under the cardiovascular indication), you must go through the plan rather than the Bridge.
You do not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, since those conditions may already qualify for GLP-1 coverage through standard Part D.
You are at least 18 and meet one of these health thresholds: BMI of 35 or higher; BMI of 30 or higher with heart failure, hard-to-control high blood pressure, or stage 3a or higher chronic kidney disease; or BMI of 27 or higher with prediabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease.

How to Get It

You do not enroll yourself. Your doctor submits a prescription and prior authorization form to a central processor run by Humana on behalf of CMS, not to HealthSpring.⁵ If approved, you bring your Medicare ID to the pharmacy and the claim runs through a dedicated billing channel. Medicare sends a confirmation letter, and refills on the same medication do not require a new authorization.¹⁰

The $50 copayment does not count toward your Part D deductible or your annual out-of-pocket spending limit. Extra Help does not reduce it, and it cannot be combined with manufacturer coupons or discount programs.⁹

Requesting a Formulary Exception From HealthSpring

If the Bridge program and the cardiovascular indication are both off the table, you or your prescriber can ask HealthSpring to cover Wegovy by exception. HealthSpring handles coverage determinations through Express Scripts.¹¹

Your prescriber must submit a written statement explaining why Wegovy is medically necessary. Requests go to Express Scripts online, by phone at 1-877-813-5595, by fax at 1-866-845-7267, or by mail to P.O. Box 66571, St. Louis, MO 63166-6571.¹¹ HealthSpring must decide within 72 hours of receiving the doctor’s supporting statement, or within 24 hours if the prescriber certifies that waiting could harm your health. A missed deadline sends the request to an independent review organization automatically.

Under the Cigna National Formulary policies that govern HealthSpring’s drug reviews, approvals require meeting product-specific criteria, may require documented evidence that you tried other therapies first, and are generally valid for 12 months.¹² A denial comes with written appeal instructions.

What Wegovy Would Cost If the Exception Is Granted

Because Wegovy is not on the formulary, HealthSpring has no published price for it. An approved exception would most likely place Wegovy on Tier 5, the specialty tier. On one HealthSpring HMO plan, Tier 5 drugs carry 28% coinsurance.¹³ On a HealthSpring D-SNP plan, Tier 5 coinsurance is 25%.¹⁴ At Wegovy’s retail price, that coinsurance can mean several hundred dollars a month before you reach catastrophic coverage, consistent with the $325 to $430 range reported for similar plans.⁷ The Bridge program’s flat $50 is far cheaper for anyone who qualifies.

Manufacturer Assistance

Novo Nordisk, the maker of Wegovy, discontinued its patient assistance program for Medicare beneficiaries with Part D coverage starting in 2026. There is no manufacturer copay card or free-drug program currently available to HealthSpring members. For free, personalized help comparing options or working through coverage, contact your local State Health Insurance Assistance Program (SHIP) or use the Medicare Plan Finder at Medicare.gov.¹⁵

What Happens After the Bridge Ends

The Bridge is a stopgap until a longer-term program called BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive Health) launches in Medicare Part D on January 1, 2027. Under BALANCE, Part D plans would opt in to cover GLP-1 medications for weight loss alongside lifestyle support. Novo Nordisk and Eli Lilly have agreed to participate, and CMS set a threshold requiring 80% of Part D sponsors to sign on for the program to move forward in Medicare. Whether HealthSpring or its parent, Health Care Service Corporation, will participate is not yet public, and if the threshold is not met there could be a gap in coverage after the Bridge ends.¹⁶

HealthSpring Customer Service can confirm current plan details at 1-800-222-6700.¹⁷

1
HealthSpring. HealthSpring Extra Rx (PDP) Formulary 2026
2
KFF. A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People With Obesity
3
MedicareResources.org. Does Medicare Cover Ozempic and Other Drugs Prescribed for Weight Loss
4
FDA. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults With Obesity or Overweight
5
CMS. Medicare GLP-1 Bridge
6
Novo Nordisk. Heart.Wegovy.com
7
U.S. News & World Report. Does Medicare Cover Ozempic
8
Medicare.gov. Weight Loss Drugs
9
Medicare Rights Center. GLP-1 Weight Loss Drug Demonstration Begins July 2026
10
Medicare.gov. Medicare GLP-1 Bridge: GLP-1 Drugs for $50 a Month
11
HealthSpring. Coverage Decisions
12
Cigna. Coverage Position Criteria: Formulary Exception
13
HealthSpring. HealthSpring Preferred (HMO) Annual Notice of Changes 2026
14
HealthSpring. HealthSpring TotalCare Plus (HMO D-SNP) Evidence of Coverage 2026
15
MCT2D. NovoCare Discontinues Assistance Program for Medicare Patients in Need
16
KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid
17
HealthSpring. HealthSpring Plans Offer Customers Many Options for 2026