{"id":456929,"date":"2026-02-08T19:48:11","date_gmt":"2026-02-08T19:48:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/456929\/"},"modified":"2026-02-08T19:48:11","modified_gmt":"2026-02-08T19:48:11","slug":"does-medicare-cover-ozempic-and-other-weight-loss-drugs","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/456929\/","title":{"rendered":"Does Medicare Cover Ozempic and Other Weight Loss Drugs?"},"content":{"rendered":"

About 9 percent of adults 65 and older are now using GLP-1s, a lower rate than the 22 percent of adults age 50 to 64, according to\u00a0a KFF poll<\/a>\u00a0released Nov. 14. The lower usage is likely because Medicare doesn\u2019t cover prescriptions specifically for weight loss, the nonpartisan health policy nonprofit says.<\/p>\n

Administration officials expect that percentage to rise to 10 percent, about 7 million people,\u00a0with the GLP-1 discounts.<\/p>\n

What if I don\u2019t have Medicare Part D yet?<\/p>\n

If you\u2019re still working or have prescription coverage outside of Medicare or other government programs, you have the option to buy through TrumpRx. The site\u2019s lowest prices for GLP-1s in early February included $149 a month for the Wegovy pill,\u00a0$199 for\u00a0the Wegovy and Ozempic pens, and $299 a month for Zepbound; higher doses cost more.\u00a0\u00a0<\/p>\n

The site lists 43 brand-name drugs and says more will be added. Consumers can get the prices at local pharmacies using the TrumpRx coupons, but other prescriptions are available only through the manufacturer\u2019s website.<\/p>\n

If the FDA approves a different GLP-1 called orforglipron that\u2019s now being studied to treat type 2 diabetes and obesity, it will be about $350 a month.<\/p>\n

How they work. GLP-1s 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.<\/p>\n

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.<\/p>\n

Nearly 40 percent of Americans age 60 and older are considered obese \u2014 defined as having a\u00a0body mass index<\/a>\u00a0(BMI) of 30 or higher based on height and weight \u2014 according to the Centers for Disease Control and Prevention (CDC). Obesity increases the risk of heart disease, stroke,\u00a0type 2 diabetes<\/a>\u00a0and other conditions.<\/p>\n

Extra health benefits. Doctors have been prescribing GLP-1s for weight loss because studies have found that losing 5 percent to\u00a010 percent of your weight<\/a>\u00a0can have positive effects on your health.\u00a0In drug trials sponsored by manufacturer Novo Nordisk, the Wegovy pill resulted in an average weight loss of more than 16 percent\u00a0for those who took it as directed.<\/p>\n

In addition to helping with weight loss, GLP-1s, or glucagon-like peptide-1 receptor agonists, have been found to improve heart and liver health and\u00a0treat sleep apnea<\/a>\u00a0in overweight adults. They\u2019ve also been shown to reduce\u00a0complications from kidney disease<\/a>\u00a0and even protect the brain.<\/p>\n<\/p>\n

Isn\u2019t Medicare banned from covering weight-loss drugs?<\/p>\n

Yes, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 prohibits\u00a0Part D plans<\/a>\u00a0from 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.<\/p>\n

Drugs prescribed for weight gain, cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction also aren\u2019t allowed to be covered. Medicare now covers GLP-1s for diabetes and other approved ailments,\u00a0such as obesity<\/a>\u00a0in conjunction with\u00a0heart disease<\/a>.<\/p>\n

\u201cThere 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,\u201d says Juliette Cubanski, deputy director of the program on Medicare policy for KFF.<\/p>\n

What uses of GLP-1 medications have been covered?<\/p>\n

In January 2025, CMS selected Ozempic, Rybelsus and Wegovy, all GLP-1s manufactured by Novo Nordisk, for its second round of\u00a0Medicare drug price negotiations<\/a>.\u00a0The Medicare-negotiated prices, effective in 2027, will be $274 for a 30-day supply.<\/p>\n

But Medicare has been covering five medications for several years, just not for weight loss.<\/p>\n

1. Mounjaro\u00a0(tirzepatide) is an FDA-approved diabetes drug that isn\u2019t 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.<\/p>\n

2. Ozempic\u00a0(semaglutide) was approved in 2017 by the FDA for treating diabetes, and approval was expanded to cardiovascular disease and\u00a0kidney disease<\/a> but not weight loss, even though\u00a0some people use it off-label<\/a>\u00a0for that purpose.<\/p>\n

3. Rybelsus\u00a0(semaglutide) was the first-ever GLP-1 pill to be given the FDA\u2019s OK. The once-a-day tablet is prescribed for type 2 diabetes to help control blood sugar\u00a0levels along with diet and exercise and reduce the risk of heart attack or stroke, but in medical trials Rybelsus\u2019 lower doses have resulted in fewer pounds lost compared to the other, higher-dose GLP-1s that are injected once a week.<\/p>\n

4. Wegovy\u00a0(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.\u00a0In mid-August 2025, the FDA also OK\u2019d Wegovy to treat a serious liver disease called\u00a0metabolic-associated steatohepatitis<\/a>\u00a0(MASH) that develops when fat buildup in the liver causes inflammation and scarring.<\/p>\n

5. Zepbound\u00a0(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.<\/p>\n

When deciding what medication to prescribe, Sha\ufeffuna Levy, M.D., medical director of the Tulane Bariatric and Weight Loss Center in New Orleans, says insurance is her number one limiting factor.<\/p>\n

\u201cWith obesity, every insurance and every employer follow their own plan,\u201d she says. \u201cWe 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.\u201d<\/p>\n

Medicare beneficiaries who will be eligible for lower-cost GLP-1 medications include those with a body mass index (BMI) of:<\/p>\n

Outside of Medicare, 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.\ufeff<\/p>\n

\u201cYou 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\u2019s covered for diabetes\u201d or sleep apnea, Cubanski says.<\/p>\n

Can I get Ozempic, Wegovy, Zepbound covered now?<\/p>\n

If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it.\u00a0Rybelsus also can be prescribed for diabetes and Wegovy for cardiovascular disease and MASH.<\/p>\n

Together, Medicare spent $15.2 billion on these drugs in 2024, making them the top medications the agency spends the most on.\u00a0But plans often decide on\u00a0prior authorization requirements<\/a>\u00a0showing that people meet the risks for particular diseases<\/p>\n

Some plans require you to try other less expensive medications first. Similar rules apply to Mounjaro and Zepbound.<\/p>\n

Even though the Medicare Plan Finder\u00a0may identify the brand-name drugs as covered, that doesn\u2019t mean you\u2019ll qualify. You\u2019ll need to share documentation of your diagnosis with your Part D plan.<\/p>\n

\u201cOzempic is a medication for diabetes,\u201d Levy said before its approval for kidney disease. \u201cPeople call their insurance and ask if Ozempic is covered, and they say it is, but if you don\u2019t have diabetes, it\u2019s not covered.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"About 9 percent of adults 65 and older are now using GLP-1s, a lower rate than the 22…\n","protected":false},"author":2,"featured_media":456930,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[58],"tags":[97,1342,123938,243,1623,249,142012,122325,8230,3458,12646,93050],"class_list":{"0":"post-456929","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-medication","8":"tag-health","9":"tag-medicare","10":"tag-medicare-part-d","11":"tag-medication","12":"tag-mounjaro","13":"tag-ozempic","14":"tag-rybelsus","15":"tag-trumprx","16":"tag-wegovy","17":"tag-weight-loss","18":"tag-weight-loss-medication","19":"tag-zepbound"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/456929","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=456929"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/456929\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/456930"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=456929"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=456929"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=456929"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}