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Does Medicare cover Ozempic and drugs taken for weight loss?


Medicare doesn’t cover drugs prescribed for weight loss, but it covers popular weight loss drugs Ozempic and Wegovy when they’re prescribed for other reasons. Medicare didn’t cover Wegovy when it was FDA-approved only for weight loss, but it can now cover the drug because on March 8, the FDA approved its use for adults with cardiovascular disease who are also overweight. Medicare also covers Ozempic, an FDA-approved diabetes drug that has unintentionally become popular for weight loss, when it’s prescribed for diabetes

Medicare Part D can’t cover these drugs solely for weight loss. The 2003 Medicare Part D law for prescription drug coverage specifically excludes drugs prescribed for weight loss or weight gain as well as drugs used for cosmetic purposes, fertility, hair growth, and treatment of sexual or erectile dysfunction. 

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“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, formerly the Kaiser Family Foundation. Some of the weight loss drugs from the early 2000s were pulled from the market amid safety concerns.

More than 40 percent of Americans 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 a new class of medications called GLP-1 agonists for weight loss because studies have found that losing 5 to 10 percent of your weight can have significant positive effects on your health.

What are GLP-1 medications for weight loss?

Glucagon-like peptide-1 agonist (GLP-1) is a new 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. These medications have also been found to help with weight loss because they make you feel fuller faster.

On average, the trendy GLP-1 medications have been helping people lose 12 percent of their total weight. 

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

  • Ozempic is FDA-approved for treating diabetes but not for weight loss, even though some people use it off-label for that purpose. Its popularity as a weight loss supplement is causing drug shortages, affecting those who need it to help control their diabetes.
  • Wegovy had already been approved 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. Then, on March 8, the FDA approved Wegovy for adults with cardiovascular disease who are also overweight.
  • Mounjaro (tirzepatide) is an FDA-approved diabetes drug that Eli Lilly is investigating using for weight loss.

“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,” Cubanski says. 

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.

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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.

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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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