Does medicare cover popular drugs 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 2024, 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. 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. MEDICARE AND DIABETES 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, so Medicare had not been covering it. However, the FDA approved it Dec. 20 to treat moderate to severe sleep

apnea in adults with obesity, so that opens the door for its use in weight loss. 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. Ozempic, Wegovy and another semaglutide

drug named Rybelsus are on Medicare's list for price negotiations in 2025, but any agreement on lower prices won’t take effect until 2027.