Does Medicare Cover Ozempic and Drugs Taken for Weight Loss?

“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.

Nearly 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 GLP-1 agonists for weight loss because studies found that losing 5 percent to 10 percent of your weight can have positive effects on your health.

What are 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. 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, 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.
• Wegovy is 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, and now for adults with cardiovascular disease who are also overweight.
• Mounjaro (tirzepatide) is an FDA-approved diabetes drug that Lilly is investigating using for weight loss. More than 90 percent of commercial and Part D plans cover Mounjaro for people with type 2 diabetes, according to a Lilly spokesperson. It contains the same active ingredient in the same doses as Zepbound.
• Zepbound (tirzepatide) is FDA-approved for weight loss, so Medicare had not been covering it. However, the FDA approved it Dec. 20 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 Weight Loss Center, 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 are 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. 

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.

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 and $4.6 billion in 2022, 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.

“Ozempic is a medication for diabetes,” Levy says. “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 and are also overweight. However, since the FDA approval in March, Part D plans haven’t been allowed to adjust their premiums to account for the new drug midyear; very few Part D plans currently cover the medication.

“As far as we can tell based on data from July, very few plans have opted to add coverage for Wegovy so far” in 2024, Cubanski says. “It is likely that plans are waiting to add the drug to their formularies for 2025, when they will be able to factor the cost of coverage for this drug into their premiums.”

Plans will also decide on prior authorization requirements showing that people meet the cardiovascular disease risk.

How do I get Medicare coverage for Zepbound?

Zepbound (tirzepatide) previously had not been covered by Medicare because the FDA approved it for weight loss only. In June 2024, pharmaceutical company 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 Dec. 20.

Now that the FDA OK’d the drug for sleep apnea and obesity, Medicare Part D plans are able to cover it for those reasons.

What other ways can I pay for weight loss drugs?

Other ways are available to help pay for weight loss drugs that Medicare won’t cover.

Some employer insurance. In 2024, nearly all health plans covered GLP-1s for diabetes and 44 percent of plans from companies with 500 or more employees for weight loss, according to Mercer’s National Survey of Employer-Sponsored Health Plans. Nearly 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. 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.