Does Medicare Cover Wegovy, Zepbound, and Other Weight-Loss Medications?
Key takeaways:
Medications used for weight loss, such as Ozempic (semaglutide) and Zepbound (tirzepatide), can cost over $1,000 a month without insurance.
Medicare, by law, does not cover prescription medications taken solely for weight loss. However, you may receive coverage if your weight-loss medication is FDA approved for another medically accepted indication, such as stroke prevention.
You can look into patient assistance programs or download a GoodRx coupon to save money on your medications.
More than 1 in 3 U.S. adults age 65 and older have a body mass index (BMI) that qualifies them as “obese.” Research published in early 2023 shows that obesity can contribute to many medical conditions, including high blood pressure and Type 2 diabetes, and increase your risk of death by anywhere from 22% to 91%.
Many people are turning to medications such as Ozempic (semaglutide), Wegovy (semaglutide), and Zepbound (tirzepatide) to aid with weight loss. However, the price tag for these medications can be over $1,000 per month without insurance.
If you have Medicare, you’re probably wondering if your weight-loss medications will be covered. Current legislation explicitly prevents Medicare from covering weight-loss medications unless they’re prescribed to treat another medically accepted indication, such as lowering the risk of a heart attack, stroke, or another life-threatening cardiovascular condition. We’ll explain why, and offer some other options if your medications aren’t covered by Medicare.
Why doesn’t Medicare cover weight-loss medications?
Medicare, the federal health insurance program primarily for people aged 65 and older, is currently prohibited from covering medications solely for weight-loss purposes. However, Medicare may cover certain weight-loss (bariatric) surgeries if you meet certain requirements.
The reasoning behind Medicare’s weight-loss medication ban can be traced back to the 1990s. During that time, the safety and effectiveness of obesity treatments was questioned. Consequently, the Medicare Prescription Drug, Improvement, and Modernization Act was passed in 2003 and went into effect in 2006. It created the Medicare Part D prescription medication benefit and prohibited coverage for medications that were “used for anorexia, weight loss, or weight gain.”
Another barrier to coverage has been the perception of weight-loss medications. Dr. Shauna Levy, assistant professor of surgery at Tulane University Medical Center and specialist in obesity medicine, says that “Medicare doesn’t cover medications for the purposes of weight gain or weight loss because it’s considered a cosmetic condition.”
But changes may be on the horizon. Levy adds, “Ever since 2013, when the AMA [American Medical Association] declared that obesity was a disease, there’s been some legislation that we’ve been trying to pass called the Treat and Reduce Obesity Act, which would categorize obesity as a disease and make these medications OK to be covered by Medicare.”
Save on Ozempic: From downloading a GoodRx coupon to using a manufacturer copay savings card, there are ways to save on Ozempic.
Wegovy vs. Ozempic: Your medical team may prescribe either Ozempic or Wegovy depending on your health condition.
Coverage options: If Medicare doesn’t provide coverage, Medicaid may be able to help pay for weight-loss medications.
Do other insurance plans cover weight loss medications?
Many insurers typically don’t cover the cost of weight-loss medications, which can have a price tag of over $1,000 per month. However, one survey of 500 HR decision-makers found that 25% of employers covered GLP-1 medications such as Ozempic and Wegovy in 2023, and 2 out of 5 employers plan to cover them in 2024.
Some state Medicaid programs cover weight-loss medications. But it’s not a mandatory Medicaid benefit. California, for example, has started to cover weight-loss medications on their Medicaid preferred drug lists. Medications on this list are covered without the need for a prior authorization.
For those health insurance plans that do offer coverage for weight-loss medications, the coverage can vary from one plan to another. Here are a few questions to ask your insurance company about medication coverage:
What specific medications are covered under your health plan?
Are there specific eligibility criteria?
Are weight-management programs covered?
Is prior authorization required?
What is the process for filing appeals for coverage?
Does Medicare cover Ozempic, Mounjaro, or similar medications?
Without manufacturer discounts or insurance, weight-loss medications can cost more than $12,000 per year. Below are a few popular medications that are used for weight loss and more information about cost and coverage.
Ozempic
In 2017, the FDA approved Ozempic for the treatment of Type 2 diabetes. If your healthcare professional prescribes Ozempic to manage Type 2 diabetes, then Medicare may cover it as a Part D medication. But if you take Ozempic for off-label uses such as weight loss, you’ll have to find alternative ways to pay for your medication.
If you have private or commercial insurance, you can pay as little as $25 per prescription (up to a 3-month supply) with an Ozempic savings card. The manufacturer of Ozempic, Novo Nordisk, offers a cost navigator tool to help you determine if your insurance covers the medication. The retail price can range anywhere from $1,000 to $1,200 for a one-month supply if you are paying entirely out of pocket.
Wegovy
In 2021, Wegovy was approved for chronic weight management. Since Medicare is barred from covering medications for weight loss, you’ll have to find other ways to save on your medication if it’s used solely for that purpose.
However, if you were prescribed Wegovy to prevent a heart attack, stroke, or other severe cardiovascular condition, Medicare will allow coverage for Part D enrollees. Wegovy was FDA approved in March 2024 to reduce the risk of a life-threatening cardiovascular event in adults who are considered obese or overweight and have a cardiovascular condition.
If you have private or commercial insurance, you can pay as little as $0 for a 28-day supply with a Wegovy savings offer. But without qualified insurance, you could end up paying more than $1,300 for the same supply.
Mounjaro
Mounjaro (tirzepatide) was approved to improve blood sugar control in adults with Type 2 diabetes in 2022. If your healthcare professional prescribes Mounjaro to treat Type 2 diabetes, Medicare may provide coverage. But if you are taking Mounjaro for weight loss, Medicare will not cover it.
If you are eligible for the Mounjaro Savings Card, you can pay as little as $25 for your prescription. You won’t qualify for the card, though, if you are enrolled in Medicare. The average retail price for Mounjaro is between $1,000 and $1,200 per month without insurance.
Zepbound
In November 2023, the FDA approved Zepbound, an injectable prescription medication for chronic weight management in adults who are overweight. Zepbound, developed by Eli Lilly — the same pharmaceutical company that launched Mounjaro — is a new addition to the available medications for weight loss. However, Medicare won’t cover the medication due to its existing policies.
If you have commercial insurance, you may qualify for a Zepbound savings card program. This can reduce your medication cost to as low as $25 per prescription if you qualify. But people who are enrolled in government-sponsored programs like Medicare are not eligible for this offer. Zepbound launched with a list price of $1,060 for a 28-day supply.
What resources can help pay for weight loss medications?
If you need help paying for weight-loss medications, here are some resources to consider:
GoodRx: GoodRx helps you compare prices for weight-loss medications at different pharmacies so you can find the best price in your area. You can also download free GoodRx prescription coupons to help you save money off the retail price.
Patient assistance programs: If you don’t have insurance or are underinsured, patient assistance programs can help you afford your medications. NovoCare, for example, has a patient assistance program for Ozempic.
HSA or FSA: Find out if you can use funds in your health savings account (HSA) or flexible spending account (FSA) to pay for your prescription medications. The money in your HSA rolls over every year, but you’ll have to use your FSA dollars before they expire.
The bottom line
Weight-loss medications can easily add up to over $12,000 per year. But current law doesn’t allow Medicare to cover medications such as Ozempic, Wegovy, Mounjaro, and Zepbound, for weight loss.
However, if the medications are approved for another purpose, such as Type 2 diabetes, then Medicare may cover them. If you are looking for ways to reduce the cost of your medication, you can check out resources like GoodRx to help you find the best price in your area.
Why trust our experts?
References
Accolade. (2023). GLP-1 coverage in employer plans could nearly double in 2024.
Belloni, G. (2023). Next-gen weight-loss drugs receive tentative embrace by Medicaid. Bloomberg Law.
Federal Register. (2005). Medicare program, Medicare prescription drug benefit, final rule.
Loftus, P. (2024). Medicare opens door for covering obesity drugs. Wall Street Journal.
Marshall, L. (2023). Excess weight, obesity more deadly than previously believed. University of Colorado Boulder.
McKee, A. M., et al. (2021). Obesity in the elderly. StatPearls.
NovoCare. (n.d.). Patient assistance program. Novo Nordisk.
Ovsag, K., et al. (2008). Preferred drug lists: Potential impact on healthcare economics. Vascular Health and Risk Management.
U.S. Food and Drug Administration. (2024). FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight.
Ward, A. S., et al. (2023). Benefits of medicare coverage for weight loss drugs. University of Southern California Schaeffer.
