Does Medicare Cover Weight-Loss Drugs? Understanding GLP-1 Coverage in 2025

What are GLP-1 Medications? 

GLP-1 medicines help your body manage blood sugar, and can reduce your appetite. They work by signaling your pancreas to release insulin when needed, slowing how quickly food leaves your stomach, and lowering the amount of sugar your liver produces Historically GLP-1s have been prescribed to treat Type 2 diabetes. Some brands also have additional FDA-approved uses, such as helping lower the risk of serious heart-related events in certain adults or treating obstructive sleep apnea (OSA). GLP1 medicines have become increasingly popular, and some providers use them for other purposes - sometimes “offlabel,” for prediabetes, insulin resistance, or weight related concerns. These uses are often non-FDA approved. Medicare does not cover GLP1s for non-FDA approved or weight-loss only purposes. 

Most GLP-1s are once-weekly injections at home; although more tablets are becoming available. Common side effects include nausea, diarrhea, and constipation. 

Your provider can assist you in finding affordable treatment options that work for your specific needs.

What Medicare Covers Today 

GLP-1 use for weight-loss only purposes are excluded  from Medicare Part D coverage, meaning plans are not allowed to cover them for that purpose alone.

When coverage may be possible: If a medication has an FDA-approved indication beyond weight loss, Part D plans may cover it for that specific use. Examples include: 

• Ozempic™, Rybelsus™, Trulicity™, Victoza™ and Mounjaro™ when used for blood sugar control in patients with Type 2 diabetes. 
• Wegovy™ (semaglutide) to reduce the risk of cardiovascular death, heart attack or stroke in adults with cardiovascular disease who are overweight or obese. 
• Zepbound™ (tirzepatide) for moderate to severe obstructive sleep apnea in adults with obesity.

Coverage still depends on your specific plan’s Drug List (formulary) rules. Coverage decisions are indication specific—a medication may be covered for one approved use but not for weight loss. Your plan may also have extra requirements such as prior authorization, step therapy, or quantity limits. 

If prior authorization is needed, start with your doctor. They will send your plan a request with information demonstrating medical necessity and medical records that show: 

• Your diagnosis and the FDA-approved reason for the drug 
• Recent notes, labs, or measurements (for example, A1C, BMI, heart disease or sleep apnea details) 
• What you have already tried and why it didn’t work or wasn’t safe 

Your plan reviews the request and sends a decision to you, your doctor, and your pharmacy.

At-a-Glance: Common Medications and Typical Medicare Coverage

Medication	FDA-Approved Uses Relevant to Medicare	Typical Medicare Coverage Status (dependent on formulary coverage)
Wegovy™ (semaglutide, injection, oral)	Chronic weight management; Reducing cardiovascular (CV) risk in adults with CV disease plus overweight or obesity ; Treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)	May be covered for CV-risk reduction or treatment of MASH if criteria met; not covered for weight loss alone
Ozempic™ (semaglutide, injection)	Type 2 diabetes; Reduce cardiovascular (CV) risk in adults with Type 2 diabetes and established CV disease; reduce risk of kidney disease and CV death in adults with Type 2 diabetes	May be covered for Type 2 diabetes; not covered for weight loss.
Rybelsus™ (semaglutide, oral)	Type 2 diabetes; Reduce cardiovascular (CV) risk in adults with Type 2 diabetes	May be covered for Type 2 diabetes; not covered for weight loss.
Mounjaro™ (tirzepatide, injection)	Type 2 diabetes	May be covered for Type 2 diabetes; not covered for weight loss.
Zepbound™ (tirzepatide, injection)	Chronic weight management; Obstructive sleep apnea(OSA) in adults with obesity	May be covered for OSA indication; not covered for weight loss alone.
Trulicity™ (dulaglutide, injection)	Type 2 diabetes; Reduce cardiovascular (CV) risk in adults with Type 2 diabetes	May be covered for Type 2 diabetes; not covered for weight loss.
Victoza™ (liraglutide 1.8 mg, injection)	Type 2 diabetes; Reduce cardiovascular (CV) risk in adults with Type 2 diabetes	May be covered for Type 2 diabetes; not covered for weight loss.
Saxenda™ (liraglutide 3 mg, injection)	Chronic weight management	Not covered for weight loss under Part D’s exclusion.

Note: Coverage and tiers vary by plan and state. Always check your plan’s specific Drug List (formulary).

What You Might Pay: How Medicare Drug Costs Work in 2026

Your costs depend on your specific plan, the pharmacy you use and whether your medication is covered for your diagnosis. In 2026, Medicare Part D caps out-of-pocket costs for covered drugs at $2,100; until you reach that cap, many higher-cost medicines fall on specialty tiers with coinsurance. 

• Deductible — Plans can have a deductible up to $615. You pay 100% for covered drugs until you meet it. Some plans have a lower or $0 deductible. 
• Initial Coverage Stage - After the Deductible is satisfied —Costs vary depending on the tier of the medication and the plan you have, and you will pay a coinsurance (percentage of the cost of the drug) or a co-pay (set amount). You will be responsible for this cost share until your total out of pocket reaches the maximum of $2,100.  You generally pay 25% coinsurance for covered drugs until you reach the annual $2,100 out-of-pocket maximum. Once you hit the cap, you move to the catastrophic phase.
• Catastrophic Stage – Once you have met your out-of-pocket maximum you pay $0 for the remainder of the benefit year for your covered medications.
• Note: The $2,100 cap and the above rules apply only to covered Part D drugs. If a drug is not covered for your diagnosis, Part D cost rules (including the cap) do not apply. 

Weight Loss Alternatives Covered by Medicare 

Even if a medicine isn’t covered for weight loss, Medicare may still pay for several services that help manage weight and related conditions. These benefits, when medically necessary, can work on their own or alongside medications used for other approved diagnoses. 

• Obesity Counseling Under Part B — Medicare covers intensive behavioral therapy when you have a Body Mass Index (BMI) of 30 or more and you receive counsel from a primary care practitioner in a primary care setting. Coinsurance and the Part B deductible are waived for this service. 
• Medical Nutrition Therapy — Covered under Part B if you have diabetes or kidney disease and are referred by your doctor. 
• Bariatric Surgery — Covered for certain conditions when medical criteria are met. Talk to your care team about whether you qualify. 

Will Medicare Cover Weight Loss Drugs in the Future? 

On December 23, 2025, CMS announced the Better Approaches to Lifestyle and Nutrition for Comprehensive health (BALANCE) Model, which includes a Medicare GLP1 payment demonstration scheduled to begin in July 2026.

CMS has not yet provided details on how a beneficiary would qualify, enroll, or access the demonstration. More information is expected, but no date has been provided. 

Current coverage rules still apply. The member’s medication is processed based on the current plan year formulary, including any PA (prior authorization), QL (quantity limits), ST (step therapy), or cost sharing requirements. Use of GLP-1s for non-FDA approved indications and/or weight loss is currently still excluded under Medicare part D.

Always check your plan’s Drug List and specific drug requirements. 

How Wellcare Medicare Advantage Plans Fit In

Many Wellcare Medicare Advantage plans include Part D drug coverage. These plans follow Medicare Part D rules, which means weight-loss-only drugs remain excluded, but drugs may be covered for other FDA-approved indications if they are on the plan’s Drug List and criteria are met.

Always check your plan’s Drug List and specific drug requirements.

Next Steps: How to Check Your Medicare Drug Coverage for GLP-1 Medications

1. Search the Drug List — Look up the drug name and dose to see if it’s covered and on which tier.
2. Review any Requirements — See if prior authorization, step therapy or quantity limits apply.
3. Ask Your Prescriber for Documentation — For covered indications, your doctor may need to provide diagnosis details, relevant labs and notes showing you meet your plan’s criteria (Remember, requirements vary by plan)

8 a.m.-8 p.m., 7 days a week.

Frequently Asked Questions (FAQs)

Does Medicare Cover Weight Loss Drugs?

No. Medicare Part D excludes drugs used for weight loss. Some of these medications may be covered for other FDA-approved medical uses that are not weight loss, depending on your plan.

Do Wellcare Medicare Advantage plans cover Ozempic, Mounjaro or Trulicity?

They may cover these medicines for Type 2 diabetes if the drug is on your plan’s Drug List and you meet the plan criteria. They are not covered for weight loss. Check your specific plan’s Drug List.

Is Ozempic Covered by Medicare?

In some cases. Medicare Part D plans may cover Ozempic, when it’s prescribed for Type 2 diabetes and listed on your plan’s Drug List (formulary). It is not covered for weight loss. Always check your plan for prior authorization, step therapy or quality limits. Or call the number on your member ID card.

Is Wegovy Covered by Medicare?

Wegovy may be covered only when prescribed to reduce cardiovascular risk in adults with established cardiovascular disease who are overweight or obese, and only if your plan lists it on the Drug List. It is not covered for weight loss alone. 

Is Zepbound Covered by Medicare?

Zepbound may be covered when prescribed to treat obstructive sleep apnea in adults with obesity, if your plan lists it and criteria are met. It is not covered for weight loss alone.

Can a Doctor Prescribe a Drug “Off-Label” and Have Medicare Cover It?

Part D coverage generally follows FDA-approved and other musically accepted indications. Drugs used for weight loss remain excluded even if prescribed off-label. Your plan will review clinical documentation if prior authorization is required.

What if My Drug is Not on the Drug List?

Ask your prescriber about alternatives on your plan’s Drug List or whether a formulary exception may be appropriate. Decisions are made case-by-case.

Are There Programs to Help with Medication Costs?

Yes. Many members qualify for Extra Help or state assistance programs that lower drug costs. Your pharmacist or plan can help you check your eligibility. (Program availability varies by state.)

When Will Medicare Cover Weight Loss Drugs?

There is no set date. CMS is exploring a pilot that could let some Medicare Part D plans cover GLP-1s for weight management in the future, with Medicare participation as early as 2027. Details are not final, so today’s rules still apply. 

Sources

• Lilly.com: Zepbound medication guide 
• Lilly.com - Mounjaro medication guide
• FDA.gov - Wegovy prescribing information
• FDA.gov - Victoza prescribing information 
• FDA.gov - Rybelsus prescribing information
• FDA.gov - Trulicity prescribing information
• FDA.gov - Ozempic prescribing information

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

“Wellcare” is issued by WellCare Prescription Insurance, Inc.

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