Does Medicare Cover GLP-1s for Weight Loss Only?

Eligible beneficiaries also must meet the program’s prior authorization criteria. To get medications covered under the new program, providers must submit a prior authorization request and a prescription for an eligible GLP-1 drug for an approved use. The pharmacist then submits the request to the bridge program, which reviews it.

CMS is aiming for a 72-hour turnaround for prior authorization decisions. If the request is approved, the pharmacy can then fill the prescription. 

Providers must attest that the prescribed GLP-1 is to reduce excess weight and maintain weight loss in combination with lifestyle changes, including diet and exercise, CMS says.

Once the first 28- or 30-day prescription is approved through the program, subsequent ones won’t require prior authorization unless the beneficiary switches to a different covered medication, CMS says.

GLP-1s, or glucagon-like peptide-1 receptor agonists, 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.

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

GLP-1s have health benefits and risks

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 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 may even protect the brain.

But the drugs also present some risks for older patients. These include possible interactions with other drugs, potential muscle and bone loss, dehydration, and gastrointestinal issues like nausea, vomiting and diarrhea.

In January 2025, CMS selected Ozempic, Rybelsus and Wegovy, all GLP-1s with the same active ingredient manufactured by Novo Nordisk, for its second round of Medicare drug price negotiations. The Medicare-negotiated prices, effective starting in 2027, will be $274 for a 30-day supply, although enrollees’ cost sharing will likely be considerably lower. Part D plans are required to cover drugs with Medicare-negotiated prices.

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

Earlier in 2026, the White House debuted a new direct-to-consumer portal, TrumpRX, which offers coupons for retail pharmacies and links users to manufacturers’ websites where they can purchase GLP-1s and other prescription medications. Other consumer prescription drug websites, and some drug company sites, provide similar offerings. These sites typically don’t work with prescription drug insurance, so any purchases won’t count toward your deductible or out-of-pocket limit.

Federal law prohibits drug companies from offering copayment coupons to people in government health care programs, including Medicare. Drug companies that manufacture GLP-1s have the same restrictions on their own direct-to-consumer websites tthat are not linked through TrumpRx.Shop around before you make a purchase.

​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, vice president and director of the Program on Medicare Policy at KFF.

What uses of GLP-1 medications have been covered?

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. It contains the same active ingredient as Rybelsus and Wegovy.

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 with 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.

A sixth medication, Foundayo (orforglipron), is covered on a limited basis through the end of 2027 under Medicare’s GLP-1 Bridge pilot program. Eligible Part D enrollees who meet the program’s medical criteria can get a month’s supply of tablets for a $50 copay.

Even enrollees in some less common Part D plan types can qualify for the Bridge program if they also have a stand-alone Part D plan. This includes those in the Program of All-inclusive Care for the Elderly (PACE), which is available in some states and allows people who need nursing home care to remain at home.

When deciding what medication to prescribe, Dr. Shauna Levy, 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 and surgical weight loss and what medications are approved.”

Outside Medicare, typical requirements for GLP-1 coverage 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. “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 through Part D?

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 under the Part D benefit.

Together, Medicare spent $15.2 billion on these drugs in 2024.

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 it was approved 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. Some retiree plans cover weight loss medications. You may need to have a certain BMI and participate in a weight loss coaching program to get coverage.

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.