Does Medicare cover Ozempic and other drugs prescribed for weight loss?
Answered by 9 licensed agents
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.
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
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.
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
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.
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.
