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

To fight obesity, Medicare — and Medicaid — will cover GLP-1s at a reduced cost, the White House says

Tony Pugh and Kimberly Lankford,

Updated November 21, 2025

AARP

Reviewed by

Leigh Purvis, MPA

En español

Published September 13, 2023

/ Updated November 21, 2025

syringe of weight loss drugs with the silhouette of a body on red background

Getty Images

Key takeaways

Medicare, Medicaid start an obesity pilot program in 2026.
Federal law bans weight-loss drug coverage in Medicare.
GLP-1s treat heart disease, diabetes. Valued for weight loss.
Some Part D plans pay for Ozempic, Wegovy, Zepbound.
If yours doesn’t, you may be able to get financial help.

While Medicare covers popular weight loss drugs like Ozempic and Wegovy only when they’re prescribed for other ailments, mainly diabetes, the White House says that policy will be changing soon.

In November, the White House announced that leading GLP-1 manufacturers Eli Lilly and Novo Nordisk will lower prices for the popular medications when they’re purchased through Medicare. The discounts also would apply to purchases made via a new direct-to-consumer portal, TrumpRx, scheduled to launch in early 2026 to link users to manufacturers’ websites to buy the prescriptions.

“Coverage and pricing changes will phase in during 2026 with cash prices [for TrumpRx purchases] as early as January, Medicare access by midyear and Medicaid timing varying by state participation,” says Michael Baker, director of health care policy at the American Action Forum. The Washington-based nonprofit is a domestic and fiscal policy think tank.

$50 copayments. Copays for Medicare enrollees who have stand-alone Part D prescription plans in original Medicare or Medicare Advantage plans with drug coverage and use Mounjaro, Ozempic, Wegovy or Zepbound will be around $50 a month after any deductibles have been met, administration officials say. The federal government will pay $245, a price that also will be available to state Medicaid programs.

Medicare and diabetes

About 9 percent of adults 65 and older are now using GLP-1s, a lower rate than the 22 percent of adults age 50 to 64, according to a KFF poll released Nov. 14. The lower usage is likely because Medicare doesn’t cover prescriptions specifically for weight loss, the nonpartisan health policy nonprofit says.

Administration officials expect that percentage to rise to 10 percent, about 7 million people.

$350 without insurance. The White House says 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.

All four medications are taken via injection, but if the federal Food and Drug Administration (FDA) approves an oral GLP-1 called orforglipron that’s now being studied, it also will be about $350 a month. A pill version of Wegovy in development could cost $150 on the website, pending FDA approval.

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.

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 beginning in 2026. However, the new 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.

Coverage is expected to kick in around the middle of next year.

In January 2025, the Centers for Medicare & Medicaid Services (CMS) selected Ozempic, Rybelsus and Wegovy, all GLP-1s manufactured by Novo Nordisk, for its second round of Medicare drug price negotiations. But any agreement on lower prices from those negotiations won’t take effect until 2027.

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 now 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.”

Without insurance, these medications have been expensive, often costing $1,000 to $1,400 a month or $12,000 to more than $16,000 a year.

“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.

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.

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 2024. 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.

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This story, originally published Sept. 13, 2023, was updated to reflect the recently announced Medicare coverage of weight loss drugs for obesity and lower copays.

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About the authors

Tony Pugh is an award-winning writer and editor covering Medicare for AARP. He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

About the reviewer

Leigh Purvis, prescription drug policy principal at the AARP Public Policy Institute, is also chairman of the governance board for the nonprofit Institute for Clinical and Economic Review, has held a variety of health care policy positions at AARP for more than 20 years and previously worked at the American Psychological Association. She earned her master’s degree in public administration and policy from George Mason University and has a certificate in gerontology from the University of Washington.