Does Medicare cover Ozempic and other drugs prescribed for weight loss?

Does Medicare cover Ozempic and other drugs prescribed for weight loss?

If a prescription drug is being used for weight loss rather than to treat another medical condition, Medicare Part D (Medicare prescription coverage) will not cover the drug. But if the drug is prescribed to treat another medical condition – such as Type 2 diabetes – it can be covered by Medicare Part D.¹

However, a new pilot program, called the Medicare GLP-1 Bridge, is giving some Medicare beneficiaries access to certain GLP-1 medications for $50/month.²

Which GLP-1 drugs can Medicare enrollees get for $50/month?

The Medicare GLP-1 Bridge program runs from July 1, 2026 through December 31, 2027. Under this program, some people with Medicare Part D (stand-alone or as part of a Medicare Advantage plan) can access these GLP-1 medications for a $50 monthly copay:

• Foundayo (daily oral tablet)
• Wegovy (weekly injection or daily oral tablet)
• Zepbound (KwikPen injection only; other forms of Zepbound are not included)

To qualify for this program, a Medicare beneficiary must:

• Be at least 18,
• Be enrolled in a Medicare Part D plan that does not cover their GLP-1 medication,
• Not have Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease,
• Have a Body Mass Index (BMI) that is:
  • At least 35.
  • At least 30, along with certain types of heart failure OR uncontrolled high blood pressure OR chronic kidney disease.
  • At least 27, along with prediabetes OR a history of heart attack, stroke, or artery blockages in the arms or legs.

Note: The Medicare GLP-1 Bridge program is operating outside of the normal Medicare Part D rules. So the $50/month copay does not count toward the person’s Part D deductible, nor does it count toward their $2,100 out-of-pocket maximum for 2026,² or the $2,400 out-of-pocket maximum for 2027.³

Why does Medicare not cover weight-loss drugs?

Under long-standing federal rules, medications “used for anorexia, weight loss, or weight gain, are specifically excluded from the definition of Part D drugs.”⁴

But glucagon-like peptide-1 (GLP-1) receptor agonists such as Ozempic and Mounjaro can be covered by Medicare Part D if they’re prescribed for other medical conditions.⁵

Note: If a Part D plan is an “enhanced alternative coverage” plan, drugs that would otherwise have to be excluded, including medication to treat obesity, may be covered by the plan as supplemental drugs.⁶ The full premium cost for the coverage of the supplemental drugs is paid by the enrollee and is not subsidized by Medicare.⁷ But enhanced alternative coverage plans are not required to cover weight-loss medications.

Most GLP-1 drugs were initially approved by the FDA to treat Type 2 diabetes.⁸ But the list of conditions that can be treated with GLP-1 medications is expanding, as the drugs have been found to improve outcomes for patients with cardiovascular disease, kidney disease, liver disease, sleep apnea, and various other disorders, as well as their efficacy in helping people lose weight.⁹

If a GLP-1 medication is prescribed to treat a condition other than obesity or overweight, Medicare Part D plans can cover it. For example, Wegovy received FDA approval in 2024 to reduce the risk of serious cardiovascular events in adults who have cardiovascular disease in addition to obesity or overweight.¹⁰ Later that year, Zepbound received FDA approval to treat obstructive sleep apnea.¹¹ And in 2025, the FDA approved Wegovy to treat severe fatty liver disease.¹²

As a result, those GLP-1 drugs can be covered by Medicare Part D when prescribed to treat those conditions (this is why patients with Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease aren’t eligible for the Medicare GLP-1 Bridge program, as their Part D plans are allowed to cover GLP-1 drugs to treat those conditions).²

CMS added clarity to this topic in a March 20, 2024 memo.⁵ The agency reiterated the fact that Medicare Part D cannot cover medications used for weight management. But CMS noted that the same medications can be covered by Medicare Part D if they’re prescribed to treat another medical condition:

“For example, a glucagon-like peptide 1 (GLP-1) receptor agonist that receives FDA approval for chronic weight management alone would not be considered a Part D drug. If this same drug also receives FDA approval to treat diabetes or reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight, then it would be considered a Part D drug for those specific uses only”

Nothing has changed about the underlying rules, but as noted above, some GLP-1 medications have since received FDA approval to treat other medical conditions. If they’re prescribed for that purpose, rather than being prescribed for weight loss, Medicare Part D plans are allowed to cover them.

In November 2024, CMS proposed a rule change that would have allowed Medicare Part D to cover drugs prescribed for weight loss to treat obesity, starting in 2026.¹³ But in April 2025, when the final rule was published, CMS (under a new administration) noted that they had decided not to finalize that portion of the proposed rule.¹⁴ So nothing has changed about Medicare Part D coverage of GLP-1 drugs: They continue to only be covered if they’re prescribed to treat another condition, like diabetes, but not if they’re prescribed just to treat obesity.

But as explained above, the Medicare GLP-1 Bridge program is allowing some Medicare Part D enrollees to access certain GLP-1 drugs for $50/month, through the end of 2027.

How much will I pay for a GLP-1 drug under Medicare Part D?

If you’re prescribed a GLP-1 for Type 2 diabetes, cardiovascular risk reduction, obstructive sleep apnea, or severe fatty liver disease, your out-of-pocket costs will depend on the specific drug and your Medicare Part D coverage details, including whether your plan has that particular drug on its formulary (covered drug list).

Your out-of-pocket costs will also depend on whether you’ve already met your Medicare Part D deductible (if your plan has one), and whether you’ve reached the Part D annual out-of-pocket maximum ($2,100 in 2026, and $2,400 in 2027).¹⁵

You can use the Medicare Plan Finder to see how various plans in your area would cover GLP-1 drugs. As an example, we’ll consider plans in Illinois (using 60647 as the zip code) and look at coverage for Ozempic and Mounjaro.

First, let’s consider stand-alone Medicare Part D plans (PDPs) in the 60647 zip code (in the Illinois PDP region):¹⁶

• Several stand-alone Medicare Part D plans are available that cover both drugs as long as they’re prescribed for something other than weight loss.
• Across the stand-alone Medicare Part D plans in Illinois, the total out-of-pocket cost for Ozempic from August to December 2026 (the rest of the year) ranges from about $670 to about $1,710, depending on the plan and the pharmacy, while the total out-of-pocket cost for Mounjaro ranges from about $670 to about $1,812.
• As long as the drugs are covered by the plan, the annual Part D out-of-pocket maximum will apply, limiting total out-of-pocket costs for all covered drugs to no more than $2,100 in 2026, and $2,400 in 2027.

Now let’s use the Medicare Plan Finder to look at Medicare Advantage plans with integrated Part D coverage (MA-PDs), available in the Chicago, Illinois area (zip code 60647):

• There are 56 Medicare Advantage plans available. Forty-nine of them are MA-PDs (the other seven do not include Part D prescription coverage).¹⁷
• All 49 of the MA-PDs cover Ozempic and Mounjaro when prescribed for a medical condition other than weight loss. On those plans, the out-of-pocket cost for each drug from August-December 2026 can be as low as $225 to as high as $1,665, depending on the plan and the pharmacy.
• As long as a drug is covered by the MA-PD, total out-of-pocket costs (for all covered drugs) won’t exceed $2,100 in 2026, or $2,400 in 2027.

This illustrates how much variation there can be from one PDP or MA-PD to another, in terms of whether a given drug is covered and if so, how much it will cost to fill the prescription. These variations are a reminder of why it’s so important to carefully compare the available plan options each year during the annual Medicare open enrollment period.

If you’re enrolled in Medicare and discussing a GLP-1 with your doctor, you’ll want to make sure you understand your plan’s formulary and out-of-pocket costs and include that in your conversations with your doctor.

Keep in mind that your Medicare Part D plan – either a PDP or an MA-PD – cannot provide any coverage for a GLP-1 if it’s prescribed for weight loss (unless it’s an enhanced alternative coverage plan, as described above). So even if your plan covers the drug you and your doctor are considering, that coverage will only be available if the medication is prescribed to treat a medical condition other than obesity or overweight.

And carriers are increasingly checking to make sure that the prescription isn’t for weight loss. Some major Medicare Advantage insurers have begun using a prior authorization process to make sure that they’re only covering GLP-1 drugs for patients who have been diagnosed with Type 2 diabetes.⁶

How much does Medicare spend on GLP-1 drugs?

Total gross Part D spending on GLP-1 medications grew from $5.7 billion in 2022 to $27.5 billion in 2024.¹⁸

Given that Medicare Part D does cover GLP-1 drugs when they’re prescribed for something other than weight loss, and given that the list of conditions for which GLP-1 medications are approved has grown, it’s not surprising to see that total Medicare Part D spending on these drugs has ballooned in recent years.

If a Medicare beneficiary has private drug coverage, can it cover weight-loss drugs?

Although most Medicare beneficiaries have drug coverage under Medicare Part D, more than 16% have another source of drug coverage – typically from a current or former employer, with or without the retiree drug subsidy program.¹⁹

If you’re enrolled in Medicare and your drug coverage is not provided via a PDP or MA-PD, the specifics of your coverage will depend on your plan. It might cover GLP-1 drugs when they’re prescribed for weight loss, as it wouldn’t have the same statutory prohibition that applies to Part D coverage.