Does Medicare Cover GLP-1s?

Why weight-loss drugs are excluded

The 2003 Medicare Modernization Act explicitly excludes drugs "used for the treatment of anorexia, weight loss, or weight gain" from Part D coverage. That statute — not a policy choice — is why Wegovy and Zepbound aren't covered for weight loss. Only Congress can change it, and multiple bills have been introduced but not passed as of 2026.

The Wegovy cardiovascular exception

In March 2024, the FDA approved Wegovy for cardiovascular risk reduction in adults with established heart disease and overweight/obesity. Because that's a cardiac indication (not a weight-loss indication), CMS confirmed Part D plans can cover Wegovy for this use. To qualify, patients typically need:

• Established cardiovascular disease (prior heart attack, stroke, or peripheral artery disease)
• BMI ≥ 27
• Prior authorization documenting the cardiovascular indication

Type 2 diabetes coverage

Ozempic and Mounjaro are covered on nearly every Medicare Part D formulary for adults with type 2 diabetes. Typical 2026 copays:

• Ozempic: $47–$100/mo, Tier 3
• Mounjaro: $50–$120/mo, Tier 3
• Rybelsus (oral semaglutide): $47–$100/mo, Tier 3

The 2025 $2,000 Part D out-of-pocket cap means you'll never pay more than $2,000/year for covered drugs — a major help for anyone on multiple prescriptions alongside a GLP-1.

If Medicare won't cover your GLP-1

• LillyDirect Zepbound vials: $349–$499/mo self-pay (Medicare beneficiaries eligible).
• Compounded semaglutide/tirzepatide: $150–$400/mo through telehealth providers. Legal status has tightened since the FDA declared the shortage resolved — vet the pharmacy carefully.
• Manufacturer patient assistance: Novo Nordisk and Eli Lilly both offer PAPs for low-income patients not covered by Medicare.

Wegovy and Zepbound manufacturer savings cards specifically exclude Medicare beneficiaries by federal anti-kickback rules.

FAQ