Key Takeaways
- Medicare does not cover prescription drugs used solely for weight loss. However, these medications may be covered under Medicare Part D if they are prescribed for FDA-approved uses, such as treating Type 2 diabetes or cardiovascular disease.
- Medical insurance plans (such as Medicare Advantage plans) may have additional benefits that can help with weight management.
What Are GLP-1 Medications?
GLP-1 medications (such as Ozempic) are glucagon-like peptide-1 agonists. These medications help regulate blood sugar levels, slow digestion, and reduce appetite, which supports weight loss and helps manage Type 2 diabetes, along with diet and lifestyle changes.
In recent years, medications like Ozempic have become popular for helping people lose weight. Researchers are still discovering more benefits of GLP-1 medications, and the FDA has expanded the approved indications to include reducing risk of cardiovascular events, protecting kidney functions, and obstructive sleep apnea.
Drug utilized solely for weight loss are excluded from Medicare Part D coverage. These drugs may be covered under your Medicare Part D plan if they are prescribed for FDA-approved uses, such as treating Type 2 diabetes or some cardiovascular diseases.
Medicare Coverage of GLP-1s
Below is a table showing FDA-approved indications (as of April 2025) for the most common GLP-1 medications.
|
Brand Name |
FDA-Approved Indications |
|---|---|
|
Mounjaro (tirzepatide) |
|
|
Ozempic (semaglutide) |
|
|
Rybelsus (semaglutide) |
|
|
Trulicity (dulaglutide) |
|
|
Victoza (liraglutide) |
|
|
Wegovy (semaglutide) |
|
|
Zepbound (tirzepatide) |
|
Please consult your healthcare provider and review your prescription plan's formulary to determine which strengths and dosage forms are available.
Cost
These medications can often be expensive. Depending on your plan's benefits, these medications may also be subject to a deductible. Reach out to your plan to confirm whether the deductible applies and to determine the tier level of the specific medication. If prior authorization is approved, your plan can provide the estimated cost for your next fill before you visit the pharmacy.
How Medicare Can Support Weight Loss
Medicare may not cover these medications for weight loss, but it offers other services that can help manage weight. Check with your medical insurance provider to see what benefits and resources are available to you.
Frequently Asked Questions (FAQs)
Are these medications considered Insulin?
- No, these medications are not considered insulin.
Does the $35 insulin copay cap apply to GLP-1 drugs?
- No, GLP-1 drugs are different from insulin and would not qualify for the price cap. Only covered insulin products have a $35 cap per 30-day supply.
Will my plan cover these medications for pre-diabetes?
- No, as of April 2025 no GLP-1 medications have a FDA Indication for pre-diabetes. Medicare Part D excludes coverage of medication use cases that are not FDA-approved or medically-accepted.
Can GLP-1 medications be used alongside other diabetes medications?
- Yes, GLP-1 medications are often used alongside other diabetes medications, like insulin or metformin. Using them together can help manage blood sugar more effectively.
Will my plan cover medications like Ozempic and Mounjaro for weight loss?
No, Medicare is prohibited by law from covering medications that are prescribed solely for weight loss under Medicare Part D.
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Sources
- Lilly.com: Zepbound medication guide
- Lilly.com - Mounjaro medication guide
- FDA.gov - Wegovy prescribing information
- FDA.gov - Victoza prescribing information
- FDA.gov - Rybelsus prescribing information
- FDA.gov - Trulicity prescribing information
- FDA.gov - Ozempic prescribing information
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