Does Medicare cover Ozempic and drugs taken 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” or sleep apnea, Cubanski says. 

Even though Medicare doesn’t cover drugs prescribed for weight loss, some employer coverage may. 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 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.

Keep in mind: Paying for weight loss drugs

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

Employer and 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.

This story, originally published Sept. 13, 2023, was updated to reflect new FDA approvals and additional information about Medicare coverage.

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