Key Takeaways
- Popular weight loss drugs can cost over $1,300 out-of-pocket per month in the U.S.
- Currently, Medicare doesn't cover prescription drugs that are used only for weight loss. But if the medication is also approved by the FDA for added health benefits, like treating Type 2 diabetes or cardiovascular disease, it may be covered under Medicare Part D.
- Check your Medicare Part D plan’s formulary to see what prescriptions are covered.
- Medicare Advantage plans may include additional benefits that can help with weight loss, like fitness programs.
In recent years, drugs like Ozempic have created a lot of buzz for their success in helping people lose weight, even people who have struggled with obesity for years. There are now multiple similar anti-obesity drugs on the market, including Wegovy, Mounjaro, Zepbound, and others. These medications belong to a class of drugs known as GLP-1 agonists, which help control blood glucose levels. Because these medications are so new and gaining in popularity so quickly, the out-of-pocket costs can be excessive.
If you’re currently enrolled in Medicare or will be eligible soon, you should understand what kind of access you have to these drugs, as well as what other ways Medicare can help with weight loss. In general, Medicare does not cover drugs that are prescribed solely for weight loss. However, they may be covered when they are used to treat other conditions related to obesity, like diabetes and heart disease.
We’ll break down each of the most popular weight loss drugs on the market today and how they are covered by Medicare. We’ll also offer some other ways Medicare and Medicare Advantage can help support your weight loss goals.
Medicare Coverage of Ozempic
is a brand name for semaglutide. It’s an injectable prescription that was approved by the FDA in 2017 to help adults with type 2 diabetes manage their blood sugar levels. It can also lower the risk of heart attack, stroke and death in people with heart disease and diabetes.
Does Medicare cover Ozempic?
Medicare Part D will cover Ozempic, but not if it’s prescribed solely for weight loss. For example, if your doctor prescribes Ozempic to help manage your diabetes, it is likely to be covered under Part D. However, if you are prescribed Ozempic only to help you shed excess weight, it may not be covered. In this case, you would have to pay for the medication out of your own pocket.
How much does Ozempic cost?
According to Ozempic’s manufacturer, Novo Nordisk, the list price for Ozempic without insurance coverage is $968.52 per month.
Medicare Coverage of Wegovy
What is Wegovy?
Like Ozempic, Wegovy is a brand name for injectable semiglutide, and it’s manufactured by the same company. However, Wegovy is dosed differently than Ozempic and it's FDA approved to treat obesity, whereas Ozempic is not. Adults with obesity must meet a certain BMI (body mass index) to qualify for Wegovy.
Does Medicare cover Wegovy?
Currently Medicare does not cover Wegovy solely for obesity, in keeping with the law that prevents Medicare coverage of weight loss drugs. But in early 2024, the FDA approved Wegovy to help reduce the risk of cardiovascular disease in adults who are overweight or obese. This helped pave the way for Medicare coverage of the drug, but only for people with the accompanying cardiovascular risk.
How much does Wegovy cost?
Wegovy is among the more expensive weight loss drugs on the market. People without insurance coverage can expect to pay up to $1,349 per month.
Medicare Coverage of Mounjaro
What is Mounjaro?
Mounjaro works in a similar way as Ozempic and Wegovy for help control blood sugar for people with diabets, but its active ingredient is tirzepitide as opposed to semiglutide. It was approved by the FDA in 2017 to treat Type 2 diabetes.
Does Medicare cover Mounjaro?
Medicare does not cover Mounjaro solely for obesity, and it is not approved by the FDA to be used in that way. Like the other drugs on this list, it may be prescribed by healthcare providers for this purpose, but it would be considered an “off-label” use of the drug.
How much does Mounjaro cost?
Without insurance, Mounjaro costs up to $1079.77 per month, according to Eli Lilly.
Medicare Coverage of Zepbound
What is Zepbound?
Like Mounjaro, Zepbound is also a brand name for tirzepitide and it is FDA approved help with chronic weight management. As of December, 2024, it is also the first drug to be approved by the FDA for the treatment of Obstructive Sleep Apnea.
Does Medicare cover Zepbound?
It was announced in January 2025 that because the drug can now be prescribed for OSA and not just to help with weight loss, Medicare can cover the drug for that purpose. It’s important to always check your Medicare Part D plan’s formulary to see what specific drugs are covered. Again, because Medicare currently does not cover weight loss only drugs, patients would be required to pay out of pocket for a prescription for Zepbound meant to help control weight.
How much does Zepbound cost?
The list price for Zepbound with no insurance coverage is currently $1,086.31 per month.
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What the Future May Hold for Medicare Coverage of Weight Loss Drugs
While it may not be possible to get Medicare prescription coverage for people who need these drugs solely for weight loss right now, that may change in the coming years. In November, 2024, the Biden administration proposed a new rule that would allow the coverage of these medications by Medicare and Medicaid specifically to treat obesity.
The rule highlights the fact that obesity itself is recognized as a chronic disease that is both dangerous and widespread in the U.S. Such coverage would greatly expand access to these medications. The incoming Trump administration will be tasked with the decision on whether to move forward with the proposal.
How Medicare Can Support Weight Loss
While Medicare may not currently cover these medications for weight loss, it does provide other services that can help people manage weight in other ways. Medicare Part B (the medical insurance portion of Medicare) covers obesity behavioral therapy in some cases. Members must have a Body Mass Index (BMI) of 30 or above in order to qualify for this in-person preventive service.
Medicare will also cover bariatric surgery for people in cases where they meet certain conditions related to morbid obesity. The surgery would be covered by Part A if the surgery takes place in an inpatient setting, or Part B if the surgery is an outpatient procedure. Total costs vary widely and Medicare may not cover the procedure 100%. Deductibles and copayments may apply.
While Original Medicare (parts A and B) is generally limited to preventive care and treatment that is deemed medically necessary, Medicare Advantage (Part C) plans may include additional benefits to support total wellness. like fitness programs and programs that reward healthy habits. Check to see if your Medicare Advantage plan includes a fitness benefit or other services to support a healthy lifestyle.
Sources:
- KFF.org - Proposed Coverage of Anti-Obesity Drugs in Medicare and Medicaid Would Expand Access to Millions of People with Obesity
- Healthcaredive.com: Biden administration proposes Medicare, Medicaid coverage of pricey weight loss drugs
- KFF.org - KFF Health Tracking Poll May 2024: The Public's Use and Views of GLP-1 Drugs
- Lilly.com - How much should I expect to pay for Mounjaro?
- FDA.gov - FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight
- Lilly.com - How much should I expect to pay for Zepbound?
- Health System Tracker - How do prices of drugs for weight loss in the U.S. compare to peer nations' prices?
- NovoCare.com - What is the list price for Wegovy and will it impact me?
- CNBC.com - Medicare can now cover Eli Lilly's Zepbound for sleep apnea, Health Department agency says
- Medicare.gov - Obesity Behavioral Therapy
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