When Will Medicare Cover Ozempic, Other Weight-Loss Drugs?

Isn’t Medicare banned from covering weight-loss drugs?

Yes, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 prohibits Part D plans from 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.

Drugs prescribed for weight gain, cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction also aren’t allowed to be covered. Medicare now covers GLP-1s for diabetes and other approved ailments, such as obesity in conjunction with heart disease.

“There 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,” says Juliette Cubanski, deputy director of the program on Medicare policy for KFF.

What uses of GLP-1 medications have been covered?

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

But Medicare has been covering five medications for several years, just not for weight loss.

1. Mounjaro (tirzepatide) is an FDA-approved diabetes drug that isn’t 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.

2. Ozempic (semaglutide) was approved in 2017 by the FDA for treating diabetes, and approval was expanded to cardiovascular disease and kidney disease but not weight loss, even though some people use it off-label for that purpose.

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

4. Wegovy (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. In mid-August 2025, the FDA also OK’d Wegovy to treat a serious liver disease called metabolic-associated steatohepatitis (MASH) that develops when fat buildup in the liver causes inflammation and scarring.

5. Zepbound (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.

When deciding what medication to prescribe, Shauna Levy, M.D., medical director of the Tulane Bariatric and Weight Loss Center in New Orleans, says insurance is her number one limiting factor.

“With obesity, every insurance and every employer follow their own plan,” she says. “We 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.”

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

• 27 or more who have prediabetes or a history of cardiovascular disease.
• Greater than 30 who have heart failure with preserved ejection fraction — a heart that pumps normally but is too stiff to fill properly — uncontrolled high blood pressure or chronic kidney disease.
• Higher than 35.

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.

“You 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’s covered for diabetes” or sleep apnea, Cubanski says.

Can I get Ozempic, Wegovy, Zepbound covered now?

If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it. Rybelsus also can be prescribed for diabetes and Wegovy for cardiovascular disease and MASH.

Together, Medicare spent $15.2 billion on these drugs in 2024, making them the top medications the agency spends the most on. But plans often decide on prior authorization requirements showing that people meet the risks for particular diseases

Some plans require you to try other less expensive medications first. Similar rules apply to Mounjaro and Zepbound.

Even though the Medicare Plan Finder may identify the brand-name drugs as covered, that doesn’t mean you’ll qualify. You’ll need to share documentation of your diagnosis with your Part D plan.

“Ozempic is a medication for diabetes,” Levy said before its approval for kidney disease. “People call their insurance and ask if Ozempic is covered, and they say it is, but if you don’t have diabetes, it’s not covered.”

What other ways can I pay for weight loss drugs?

You can pay out-of-pocket, taking advantage of the lower prices available on drug manufacturers’ websites linked from TrumpRx. But you also have other options:

Some employer insurance. In 2025, nearly all health plans covered GLP-1s for diabetes and 49 percent of plans from companies with 500 or more employees for weight loss, according to Mercer’s National Survey of Employer-Sponsored Health Plans, the latest available. Two-thirds of companies with 20,000 or more workers covered them.

Retiree health insurance. About 50 percent of employer plans that work with Aon, a benefits consulting firm, cover weight loss medications; many continue coverage under their retiree plans. You typically need to have a certain BMI and participate in a weight loss coaching program.

Pharmaceutical assistance programs. Drug manufacturers often have programs to help with drug costs and copayments for people without insurance. Novo Nordisk offers access to a health coach for diet and exercise to help people taking Wegovy. And it has a savings card for people without insurance.

Pharmaceutical assistance programs are usually limited to FDA-approved use. Eli Lilly has a Mounjaro savings program available to adults with an on-label prescription for type 2 diabetes, but you’ll need proof of your condition to enroll in the savings program.

Tax-free money from an HSA. You can’t contribute to a health savings account after you enroll in Medicare, but if you’ve already accumulated money in an account, you can withdraw it tax-free at any time for eligible expenses. Weight loss medications can be an eligible expense if your doctor prescribes them, even if your Part D plan doesn’t cover them.

Tax-deductible medical expense. If you don’t use tax-free money from an HSA, weight loss medication prescribed for a medical condition, such as diabetes or obesity, can be a tax-deductible medical expense, says Barbara Weltman, author of J.K. Lasser’s 1001 Deductions & Tax Breaks 2026. You must itemize your deductions, and qualified medical expenses are deductible only if they’re more than 7.5 percent of your adjusted gross income.