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

Question

Larry Dalton · Accepted Answer

Approving a medication by Medicare is always based upon the justification of the medical necessity of that drug. The insurance company that underwrites the medical prescription drug plans lays out their drug plans each year to determine what will be covered under what plan. This is the time when you sit down with your Agent and review every drug plan for your ZIP Code with your prescription drugs. This is the best answer I can give you for now without knowing which drug plan you choose, and usually, there can be justification given for a weight loss drug being required.

Answered by Larry Dalton on April 17, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Gary Church · Answer

No, Medicare does not cover Ozempic.  IT could be covered under a PDP or MADP. I would recommend talking to a licensed agent or Broker to review.

Charise Karjala · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/does-medicare-cover-ozempic-and-other-drugs-prescribed-for-weight-loss#charise-karjala

Terri Reagin · Answer

Weight loss in general is not a covered expense on Medicare. I do not typically see Ozempic approved unless the person is being treated for diabetes with it.

Steven Graves · Answer

Currently, Medicare does not cover Ozempic or other medications when they are prescribed specifically for weight loss. Medicare Part D plans are prohibited by law from covering drugs used for weight reduction, even if those drugs are FDA-approved for that purpose.

However, there is an important distinction: Ozempic (semaglutide) is primarily approved for treating Type 2 diabetes, and many Medicare Part D plans do cover it when prescribed for that condition. If a physician prescribes Ozempic to manage diabetes, and the patient meets clinical criteria, coverage is likely—though prior authorization may be required, and coverage can vary by plan.

For people without diabetes who are prescribed Wegovy (another form of semaglutide specifically approved for chronic weight management), Medicare does not cover it, as it falls under the excluded category of weight-loss drugs.

If you’re unsure whether a specific medication is covered under your plan, it's a good idea to review the plan's formulary or speak with your plan provider directly.


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Christy Jones · Answer

Ozempic is covered by your prescription plan, as long as it’s on the formulary. Check your formulary whether on your Medicare Advantage plan or your stand alone prescription drug plan if you are on Original Medicare.

Answered by Christy Jones on June 4, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Joseph Meyers · Answer

Part D providers offer a very large number of prescription medicines but the part D insurance companies require that you are using the medication for its intended use and many times these diabetic drugs such as ozempic are not going to be covered if you are using them for reasons besides being diabetic

Answered by Joseph Meyers on April 7, 2025

Broker Licensed in MI & TN

Answered by Joseph Meyers Medicare Insurance Agent

James ONeal · Answer

The short answer is No!

Medicare does not cover prescription drugs used solely for weight loss. However, these medications may be covered under Medicare Part D if they are prescribed for FDA-approved uses, such as treating Type 2 diabetes or cardiovascular disease.

Medical insurance plans (such as Medicare Advantage plans) may have additional benefits that can help with weight management.

Steven Bleicher · Answer

Every doctor is required to submit his/her “Plan of Care”. This means that since Ozempic has successfully been approved by the CDC as a treatment for weight loss, its use has been justified and it will be considered as a health benefit by Medicare. Just be aware that its use can be fairly expensive. Don’t forget to check with both US & Canadian online discount pharmacies, as a comparison to your Part D Rx plan or to determine if the pharmaceutical manufacturer has a possible subsidy thru their own website.

Answered by Steven Bleicher on June 13, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Craig Kirscht · Answer

It is coverage but not for weight loss yet.  The drug may be covered with prior authorization. It is covered for type 2 diabetes.

Carlos Pratts · Answer

No, Medicare typically does not include prescription weight loss medications like Ozempic, Wegovy, or Mounjaro when they are prescribed solely for weight loss. However, if these drugs are prescribed for other medical reasons, such as Type 2 diabetes, they might be covered under Medicare Part D.

Answered by Carlos Pratts on May 19, 2025

Broker Licensed in FL

Answered by Carlos Pratts Medicare Insurance Agent

Garrett Ball · Answer

Medicare Part D, the part of Medicare that covers prescription drugs (sold through private insurance companies) does not cover Ozempic or other drugs in the same category when they are prescribed for weight loss. Many Part D plans do, however, cover Ozempic when prescribed for Type 2 diabetes. The coverage, and your share of the costs, varies depending on which Part D plan you have. But to reiterate, at the current time, Medicare Part D does not cover Ozempic or similar drugs for the prescription indication of weight loss.

Answered by Garrett Ball on June 3, 2025

Broker Licensed in NC, AL, AR & 38 other states

Answered by Garrett Ball Medicare Insurance Agent

Giulio Campanelli · Answer

Ozempic is approved for the treatment of type 2 diabetes and requires prior authorization from your healthcare provider.  Insurance will not cover it for weight loss

Fred Manas · Answer

No, Medicare generally does not cover drugs like Ozempic and Mounjaro when prescribed solely for weight loss. Medicare Part D, which covers prescription drugs, is prohibited by law from covering medications used solely for weight loss. However, Semaglutide, the active ingredient in Ozempic, is covered under Medicare Part D when prescribed for type 2 diabetes.

Answered by Fred Manas on May 14, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Gary Henderson · Answer

Yes, but those are brand drugs and typically more expensive even with insurance. Brand drugs will be covered at a % of the cost and can vary with each drug store pharmacy. You can check with your provider to see who is the lowest cost supplier.

Answered by Gary Henderson on May 23, 2025

Agent Licensed in TX, AK, AL & 46 other states

Answered by Gary Henderson Medicare Insurance Agent

Vachik Chakhbazian · Answer

Medicare does not cover drugs solely for weight loss, but it may cover drugs like Ozempic and Wegovy when prescribed for other conditions like type 2 diabetes or cardiovascular disease

Steve Brauer · Answer

Most times, Ozempic and other medications are only covered if the member's Medicare plan has them in its formulary list or if they are deemed medically necessary. If someone just wants to lose weight, Ozempic is probably not going to be a covered service.

Answered by Steve Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Deborah Webster · Answer

Drug plans do cover many weight loss drugs such as Ozempic. Be sure to look at your drug formulary to determine which medications they cover as well as any deductibles or co-pays that may apply to this medication, to determine what your out-of-pocket costs may be.

Answered by Deborah Webster on April 17, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Tony Merwin · Answer

Ozempic will only be covered if prescribed for diabetes, and included in your drug plan's formulary.

Jamie Herrick · Answer

It can if your Dr prescribes it and you meet the clinical needs per your insurance.

Lesley Burns · Answer

Medicare doesn't cover Ozempic or other drugs prescribed for weight loss. This does not matter whether the drugs were prescribed for diabetes.

Jason Kirschner · Answer

Currently, Medicare doesn't cover prescription drugs that are used only for weight loss. But if the medication is also approved by the FDA for added health benefits, like treating Type 2 diabetes or cardiovascular disease, it may be covered under Medicare Part D.

Answered by Jason Kirschner on May 14, 2025

Agent Licensed in FL

Answered by Jason Kirschner Medicare Insurance Agent

Kip Nussbaum · Answer

Medicare does not cover drugs for weight loss. Ozempic is approved for the treatment of type 2 diabetes and may be covered if prescribed to control blood glucose levels. Taking Ozempic may result in weight loss but will not be covered if prescribed for weight loss.

Answered by Kip Nussbaum on June 18, 2025

Broker Licensed in OH

Answered by Kip Nussbaum Medicare Insurance Agent

Joley Hanson · Answer

Medicare does not cover weight loss or any cosmetic type of medical procedures. Prior authorization may be required for diagnosis of diabetic treatments. Check with a licensed agent like myself to see if your plan covers the medications your physician is suggesting.

Answered by Joley Hanson on July 7, 2025

Broker Licensed in MN, FL, IA & 7 other states

Answered by Joley Hanson Medicare Insurance Agent

Barbara Hawes · Answer

Medicare plan formularies have to offer at least 2 medications in each category, of which Ozempic and other GLP-1 medications may be included. However, weight loss is not an approved classifications. If you are taking it only for weight loss, I'm afraid you will be unable to have your Medicare plan cover it. Ozempic was originally designed for diabetic management, therefore your prescription benefit will cover it to the extent that the policy allows only if there is an appropriate diagnosis in the medical record.

Answered by Barbara Hawes on July 21, 2025

Broker Licensed in NJ, AZ, CT & 18 other states

Answered by Barbara Hawes Medicare Insurance Agent

Christopher Stowers · Answer

Medicare does not cover Ozempic or other medications when prescribed solely for weight loss. However, if these drugs are prescribed for approved medical conditions like Type 2 diabetes, they may be covered under Medicare Part D.

Answered by Christopher Stowers on April 18, 2025

Broker Licensed in GA, FL, MD & 7 other states

Answered by Christopher Stowers Medicare Insurance Agent

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

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