Does Medicare cover Ozempic and drugs taken for weight loss?

Medicare doesn’t cover drugs prescribed for weight loss, but it covers popular weight loss drugs Ozempic and Wegovy when they’re prescribed for other reasons.

In early March, the Food and Drug Administration approved Wegovy’s use for adults with cardiovascular disease who are also overweight, which opened the door for Medicare Part D plans to cover it. Ozempic, an FDA-approved diabetes drug, has unintentionally become popular for weight loss, but Medicare covers it only when it’s prescribed for diabetes.

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The 2003 Medicare Part D law for prescription drug coverage specifically excludes drugs prescribed for weight loss or weight gain, as well as drugs used for cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction. 

“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, formerly the Kaiser Family Foundation. Some of the weight loss drugs from the early 2000s were pulled from the market amid safety concerns.

More than 40 percent of Americans 60 and older are considered obese — defined as having a body mass index (BMI) of 30 or higher based on height and weight — according to the Centers for Disease Control and Prevention (CDC). Obesity increases the risk of heart disease, stroke, type 2 diabetes and other conditions. Doctors have been prescribing a class of medications called GLP-1 agonists for weight loss because studies found that losing 5 to 10 percent of your weight can have positive effects on your health.

What are GLP-1 medications for weight loss?

Glucagon-like peptide-1 agonist (GLP-1) is 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. 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. 

Though some GLP-1 medications have been FDA-approved for weight loss, others have not. Novo Nordisk’s Ozempic and Wegovy have the same underlying product, semaglutide, but they come in slightly different dosages and are approved for different reasons.

• Ozempic is FDA-approved for treating diabetes but not for weight loss, even though some people use it off-label for that purpose.
• Wegovy is approved by the FDA for weight loss for people with a BMI of 30 or higher, or with a BMI of 27 or higher and at least one weight-related health issue, such as high blood pressure or high cholesterol, and now for adults with cardiovascular disease who are also overweight.
• Mounjaro (tirzepatide) is an FDA-approved diabetes drug that Lilly is investigating using for weight loss. More than 90 percent of commercial and Part D plans cover Mounjaro for people with type 2 diabetes, according to a Lilly spokesperson.
• Zepbound (tirzepatide) is FDA-approved for weight loss but not for other conditions, so Medicare doesn’t cover it.

When deciding what medication to prescribe, Shauna Levy, M.D., medical director of the Tulane Weight Loss Center, 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.”

Without insurance, these medications are expensive, often costing $1,000 to $1,400 a month or $12,000 to more than $16,000 a year. “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,” Cubanski says. 

Even though Medicare doesn’t cover drugs prescribed for weight loss, some employer coverage may. A survey from the Business Group on Health found that 92 percent of large employers covered GLP-1s for diabetes in 2023, and 46 percent covered them for weight loss.

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.