Does Medicare cover Ozempic and drugs taken for weight loss?

Without insurance, these medications are expensive, often costing $1,000 to $1,300 a month, or $12,000 to more than $15,000 a year.  

Even though Medicare doesn’t cover drugs prescribed for weight loss, employer coverage is different. A survey from the Business Group on Health found that 92 percent of large employers covered GLP-1s for diabetes in 2023, and 46 percent covered them for weight loss.

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

How do I get Medicare coverage for Ozempic?

If your doctor prescribes Ozempic for type 2 diabetes rather than weight loss, Medicare Part D can cover it. Medicare spent $2.6 billion on Ozempic in 2021, KFF reports, making it one of the 10 drugs Medicare 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.

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 and are also overweight. Part D plans will now decide whether and when to start offering the medication in their formularies as well as the medical requirements. You will likely need to receive prior authorization showing that you meet the cardiovascular disease requirements.

How can I get help paying for weight loss drugs?

Medicare doesn’t cover drugs that have been FDA-approved only for weight loss and not other conditions, and it doesn’t cover Ozempic or Wegovy if you don’t have diabetes or cardiovascular disease.

In addition, the amounts you pay for weight loss drugs not covered by Part D do not count toward out-of-pocket expenses that make you eligible for Part D catastrophic coverage.  

But other sources may help pay for weight loss drugs.

Employer and retiree health insurance. Even though Medicare doesn’t cover weight loss drugs, some employer and retiree health insurance plans do.

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 can expect requirements like having a certain BMI and participating 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. Consumers will need to prove they have type 2 diabetes 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 the 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 and 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.

Keep in mind

Even though Medicare Part D doesn’t cover weight loss drugs, Medicare Part B covers some weight loss expenses, including:  

• Weight-loss counseling. Medicare will cover counseling sessions with a medical professional for up to 12 months as a free preventive service for people with a BMI of 30 or higher. 
• Weight-loss surgery. Medicare covers some bariatric and metabolic surgeries for people who have a BMI of 35 or above in combination with other conditions, such as diabetes, high blood pressure, high cholesterol or sleep apnea.

This story, originally published Sept. 13, 2023, was updated to reflect new Medicare Part D coverage for Wegovy after the FDA approved its use for adults with cardiovascular disease.

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