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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 starting in mid-2026. But Part D won’t be involved until 2027

12-minute read

Tony Pugh and Kimberly Lankford,

Updated February 06, 2026

AARP

Reviewed by

Leigh Purvis, MPA

En español

Published September 13, 2023

/ Updated February 06, 2026

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

Getty Images

Key takeaways

Discounts now available won’t count toward Part D.
Medicare, Medicaid start obesity pilot program in mid-2026.
Lower prices extend beyond Medicare, Medicaid.
Federal law bans weight-loss drug coverage in Medicare.
GLP-1s treat heart disease, diabetes. Ozempic may be covered.
If your plan doesn’t, you may be able to get financial help.

The first oral GLP-1 to gain federal approval for weight loss is also the lowest priced GLP-1 drug listed on the White House’s new direct-to-consumer portal that debuted this week.

The Food and Drug Administration approved the once-a-day Wegovy pill in December, and pharmacies started stocking it in January. The lowest dose is available for $149 a month through TrumpRx, which offers coupons for retail pharmacies or links users to manufacturers’ websites where they can purchase prescription medications.

Yet unless you’re overweight and have another ailment, such as diabetes, Medicare won’t cover any of the popular weight loss drugs like Ozempic and Wegovy until at least July 2026. And because the program is a test, coverage will end in December 2031 unless the program is extended.

If you want to buy the Novo Nordisk medications yourself for weight loss and your doctor will write you a prescription, the legal language on the TrumpRx website indicates that Medicare, Medicaid and other government insurance can’t be used toward the site’s cash-only purchases. You must pay for it yourself, and the cost won’t count toward your Part D deductible nor Medicare's $2,100 prescription cap.

Federal law prohibits drug companies from offering copayment coupons to people in government health care programs, including Medicare. Novo Nordisk has the same restrictions on its own direct-to-consumer website not linked through TrumpRx.

You can find similar low prices elsewhere for GLP-1 medications and other drugs listed on the government website, including warehouse club pharmacies and price comparison sites. Shop around before you make a purchase.

When Medicare, Medicaid recipients will see discounts

As early as May, GLP-1 coverage for beneficiaries of Medicaid — joint federal-state health programs for people of all ages with limited incomes — will begin, the Centers for Medicare and Medicaid Services (CMS) said in late 2025. State agencies had until Jan. 8 to opt in, and CMS has yet not released a list of states that will participate.

By July, CMS will launch its own short-term program to allow eligible Medicare Part D prescription plan beneficiaries to pay $50 a month for GLP-1 medications for the rest of the year. That $50 a month also won’t count toward your Part D deductible or limit.

Medicare and diabetes

Then in January 2027, when Part D policy years begin, standalone prescription plans in original Medicare and within Medicare Advantage will have determined whether they want to be part of the 5-year CMS pilot program with the same $50-a-month cost sharing, but you’ll have to meet your plan’s deductibles first. Commercial insurers had until Jan. 8 to decide to participate.

The effort “builds upon our … goal of democratizing access to weight-loss medication, which has been out of reach for so many in need,” says Dr. Mehmet Oz, CMS administrator.

The long lead time for Part D participation allows plans to include GLP-1s in their drug coverage lists, update their computer systems and fine-tune their marketing before next year’s open enrollment Oct. 15 to Dec. 7. It also allows the government’s Medicare Plan Finder to include the information as potential enrollees shop for standalone Part D prescription plans and Medicare Advantage coverage.

$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 injectable Mounjaro, Ozempic, Wegovy, Zepbound or the Wegovy pill will be around $50 a month after any deductibles, CMS said last year. The federal government will pay $245, a price that also will be available to state Medicaid programs.

As recently as 2023 as the shots gained popularity, GLP-1 prices had risen to more than $1,300 a month before insurance.

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, with the GLP-1 discounts.

What if I don’t have Medicare Part D yet?

If you’re still working or have prescription coverage outside of Medicare or other government programs, you have the option to buy through TrumpRx. The site’s lowest prices for GLP-1s in early February included $149 a month for the Wegovy pill, $199 for the Wegovy and Ozempic pens, and $299 a month for Zepbound; higher doses cost more.

The site lists 43 brand-name drugs and says more will be added. Consumers can get the prices at local pharmacies using the TrumpRx coupons, but other prescriptions are available only through the manufacturer’s website.

If the FDA approves a different GLP-1 called orforglipron that’s now being studied to treat type 2 diabetes and obesity, it will be about $350 a month.

How they work. GLP-1s are 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.

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.

Extra health benefits. 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.

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.

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.

What uses of GLP-1 medications have been covered?

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. The Medicare-negotiated prices, effective in 2027, will be $274 for a 30-day supply.

But Medicare has been covering five medications for several years, just not for weight loss.

1. 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.

2. 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.

3. Rybelsus (semaglutide) 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.

4. Wegovy (semaglutide) received approval from the FDA for adults with cardiovascular disease who are also overweight in March 2024, 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.

5. Zepbound (tirzepatide) is FDA-approved for weight loss, so Medicare had not been covering it. However, the FDA approved it in late 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.”

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.

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, Wegovy, Zepbound covered now?

If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it. Rybelsus also can be prescribed for diabetes and Wegovy for cardiovascular disease and MASH.

Together, Medicare spent $15.2 billion on these drugs in 2024, making them the top medications the agency spends the most on. But plans often decide on prior authorization requirements showing that people meet the risks for particular diseases

Some plans require you to try other less expensive medications first. Similar rules apply to Mounjaro and Zepbound.

Even though the Medicare Plan Finder may identify the brand-name drugs as covered, that doesn’t mean you’ll qualify. You’ll need to share documentation of your 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.”

What other ways can I pay for weight loss drugs?

You can pay out-of-pocket, taking advantage of the lower prices available on drug manufacturers’ websites linked 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, the latest available. 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.

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

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.