When Will Medicare Cover Ozempic, Other Weight-Loss Drugs?

Administration officials expect that percentage to rise to 10 percent, about 7 million people, with the GLP-1 discounts. Pharmaceutical manufacturers recently have been selling their GLP-1 medications for around $500 a month when patients purchased them directly, but as recently as 2023 as the shots gained popularity, prices had risen to more than $1,300 a month before insurance.

$350 without insurance. The cost of Ozempic, Wegovy and Zepbound for everyone will fall to roughly $350 a month through TrumpRx. Mounjaro, which has the same active ingredient in the same doses as Zepbound, was not listed for reduced costs beyond Medicare beneficiaries.

The pill version of Wegovy that was just approved could cost $150 on the website. If the federal Food and Drug Administration (FDA) approves a different GLP-1 called orforglipron that’s now being studied to treat type 2 diabetes and obesity, it also will be about $350 a month.

Some experts have noted that these prices may vary depending on the dose.

In addition to helping with weight loss, GLP-1s, or glucagon-like peptide-1 receptor agonists, have been found to improve heart and liver health and treat sleep apnea in overweight adults. They’ve also been shown to reduce complications from kidney disease and even protect the brain.

Nearly 40 percent of Americans age 60 and older are considered obese — defined as having a body mass index (BMI) of 30 or higher based on height and weight — according to the Centers for Disease Control and Prevention (CDC). Obesity increases the risk of heart disease, stroke, type 2 diabetes and other conditions.

Doctors have been prescribing GLP-1s for weight loss because studies have found that losing 5 percent to 10 percent of your weight can have positive effects on your health. In drug trials sponsored by manufacturer Novo Nordisk, the Wegovy pill resulted in an average weight loss of more than 16 percent for those who took it as directed.

Isn’t Medicare banned from covering weight-loss drugs?

Yes, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 prohibits Part D plans from covering anti-obesity medications as part of the standard prescription drug benefit. The restriction followed a late 1990s scandal involving the diet pill known as fen-phen, an appetite suppressant that combined fenfluramine and phentermine and later was linked to heart disease.

Drugs prescribed for weight gain, cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction also aren’t allowed to be covered. Medicare now covers GLP-1s for diabetes and other approved ailments, such as obesity in conjunction with heart disease.

“There was skepticism of weight loss medications that existed at the time, and a sense that obesity was more of a behavioral problem than a medical condition,” says Juliette Cubanski, deputy director of the program on Medicare policy for KFF.

In April, the Trump administration rejected a Biden-era proposal to cover GLP-1s in 2026. However, the Trump administration deal with Eli Lilly and Novo Nordisk “will enable Medicare to cover Wegovy and Zepbound for patients with obesity and related comorbidities [diseases occurring simultaneously] for the first time,” the announcement said.

Novo Nordisk calls it part of a pilot program to add obesity to the list of covered medical conditions and expects that most Part D beneficiaries would be covered.

Medicare beneficiaries who will be eligible for lower-cost GLP-1 medications include those with a body mass index (BMI) of:

• 27 or more who have prediabetes or a history of cardiovascular disease.
• Greater than 30 who have heart failure with preserved ejection fraction — a heart that pumps normally but is too stiff to fill properly — uncontrolled high blood pressure or chronic kidney disease.
• Higher than 35.

In January 2025, CMS selected Ozempic, Rybelsus and Wegovy, all GLP-1s manufactured by Novo Nordisk, for its second round of Medicare drug price negotiations. 

Rybelsus was the first-ever GLP-1 pill to be given the FDA’s OK. The once-a-day tablet is prescribed for type 2 diabetes to help control blood sugar levels along with diet and exercise and reduce the risk of heart attack or stroke, but in medical trials Rybelsus’ lower doses have resulted in fewer pounds lost compared to the other, higher-dose GLP-1s that are injected once a week.

Rybelsus’ price per month was lowered to $274 as part of the negotiations, but the reduction from more than $950 a month also won’t take effect until 2027. It was not included among the medications in the November White House announcement.

What uses of GLP-1 medications have been covered?

In March 2024, the FDA approved Wegovy’s use for adults with cardiovascular disease who are also overweight, which opened the door for Medicare Part D plans to cover it.

In mid-August 2025, the FDA also OK’d Wegovy to treat a serious liver disease called metabolic-associated steatohepatitis (MASH) that develops when fat buildup in the liver causes inflammation and scarring.

Ozempic, which the FDA first approved for diabetes and then for kidney disease, is popular for weight loss, but Medicare has been covering it only when it’s prescribed for diabetes or kidney disease.

What are popular GLP-1 drugs for weight loss?

GLP-1 is a class of medications created to treat type 2 diabetes by helping the pancreas release the right amount of insulin when blood sugar levels are high. The FDA approved the first GLP-1 drug in 2005.

These medications also can help with weight loss because they make you feel fuller faster. On average, the trendy GLP-1 medications have helped people lose 12 percent of their total weight.

Though some GLP-1s have been FDA-approved for weight loss, others have not. Novo Nordisk’s Ozempic and Wegovy have the same underlying product, but they come in slightly different dosages and are approved for different reasons.

• Mounjaro (tirzepatide) is an FDA-approved diabetes drug that isn’t approved for weight loss. More than 90 percent of commercial and Part D plans cover Mounjaro for people with type 2 diabetes, according to an Eli Lilly spokesperson. It contains the same active ingredient in the same doses as Zepbound.
• Ozempic (semaglutide) was approved in 2017 by the FDA for treating diabetes and approval was expanded to cardiovascular disease and kidney disease but not weight loss, even though some people use it off-label for that purpose.
• Wegovy (semaglutide) was also approved in 2021 by the FDA for weight loss for people with a BMI of 30 or higher, or with a BMI of 27 or higher and at least one weight-related health issue, such as high blood pressure or high cholesterol, and for adults with cardiovascular disease who are also overweight and for the liver disease MASH.
• Zepbound (tirzepatide) is FDA-approved for weight loss, so Medicare had not been covering it. However, the FDA approved it Dec. 20, 2024, to treat moderate to severe sleep apnea in adults with obesity, so that opens the door for its use in weight loss.

When deciding what medication to prescribe, Shauna Levy, M.D., medical director of the Tulane Bariatric and Weight Loss Center in New Orleans, says insurance is her number one limiting factor.

“With obesity, every insurance and every employer follow their own plan,” she says. “We actually have to employ a person in our clinic whose job it is to call the insurance company for every single patient we see to figure out what are the criteria for medical weight loss, surgical weight loss and what medications are approved.”

Outside of Medicare, typical requirements include a BMI of 30 or higher or 27 or higher when combined with another health condition. Employers may stipulate that employees participate in a lifestyle modification program.

“You can get your doctor to write you a prescription for off-label use as a weight loss drug. But that definitely does not mean it will be covered by your plan as a weight loss medication, even if it’s covered for diabetes” or sleep apnea, Cubanski says.

Can I get Ozempic covered now?

If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it. Medicare spent $2.6 billion on Ozempic in 2021 and $4.6 billion in 2022, making it one of the 10 drugs it spends the most on.

Even though the Medicare Plan Finder may identify Ozempic as covered, that doesn’t mean you will qualify for coverage. You’ll need to share documentation of your type 2 diagnosis with your Part D plan.

“Ozempic is a medication for diabetes,” Levy said before its approval for kidney disease. “People call their insurance and ask if Ozempic is covered, and they say it is, but if you don’t have diabetes, it’s not covered.”

Some plans require you to try other medications first. Similar rules apply to Mounjaro.

How do I get Medicare coverage for Wegovy?

Medicare Part D plans can cover Wegovy for adults who have cardiovascular disease or the liver disease MASH and are also overweight. But plans will decide on prior authorization requirements showing that people meet the cardiovascular or liver disease risks.

How do I get Medicare coverage for Zepbound?

Before late 2024, Medicare had not been covering Zepbound because the FDA has approved it for weight loss only. In June 2024, pharmaceutical company Eli Lilly submitted a study to the FDA of tirzepatide for treatment of moderate to severe obstructive sleep apnea and obesity, and the FDA approved its use in December 2024.

Its approval for sleep apnea and obesity allowed Medicare Part D plans to cover it for those reasons.

What other ways can I pay for weight loss drugs?

You can pay out-of-pocket, taking advantage of the lower prices expected to be available on drug manufacturers’ websites linked to from TrumpRx. But you also have other options:

Some employer insurance. In 2025, nearly all health plans covered GLP-1s for diabetes and 49 percent of plans from companies with 500 or more employees for weight loss, according to Mercer’s National Survey of Employer-Sponsored Health Plans. Two-thirds of companies with 20,000 or more workers covered them.

Retiree health insurance. About 50 percent of employer plans that work with Aon, a benefits consulting firm, cover weight loss medications; many continue coverage under their retiree plans. You typically need to have a certain BMI and participate in a weight loss coaching program.

Pharmaceutical assistance programs. Drug manufacturers often have programs to help with drug costs and copayments for people without insurance. Novo Nordisk offers access to a health coach for diet and exercise to help people taking Wegovy. And it has a savings card for people without insurance.

Pharmaceutical assistance programs are usually limited to FDA-approved use. Eli Lilly has a Mounjaro savings program available to adults with an on-label prescription for type 2 diabetes, but you’ll need proof of your condition to enroll in the savings program.

Tax-free money from an HSA. You can’t contribute to a health savings account after you enroll in Medicare, but if you’ve already accumulated money in an account, you can withdraw it tax-free at any time for eligible expenses. Weight loss medications can be an eligible expense if your doctor prescribes them, even if your Part D plan doesn’t cover them.

Tax-deductible medical expense. If you don’t use tax-free money from an HSA, weight loss medication prescribed for a medical condition, such as diabetes or obesity, can be a tax-deductible medical expense, says Barbara Weltman, author of J.K. Lasser’s 1001 Deductions & Tax Breaks 2026. You must itemize your deductions, and qualified medical expenses are deductible only if they’re more than 7.5 percent of your adjusted gross income.

This story, originally published Sept. 13, 2023, was updated to reflect the FDA’s recent approval of a pill form of Wegovy and CMS’s two-step plan to lower prices for Medicare Part D enrollees.