Does Medicare Cover Ozempic?

Medicare covers Ozempic as a treatment for diabetes, but not for weight loss.
Alex Rosenberg
By Alex Rosenberg 
Edited by Holly Carey

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Medicare doesn’t cover Ozempic for weight loss, but it does cover it for diabetes treatment.

In fact, Medicare can’t cover any prescription drugs for weight loss. And because of legal barriers and cost concerns, that might not change any time soon.

Here’s what to know about Medicare coverage of Ozempic and other weight loss drugs.

What is Ozempic?

Ozempic is a brand name for semaglutide, a prescription medication manufactured and sold by Novo Nordisk. As an injection, it can help control blood sugar in people with Type 2 diabetes.

The Food and Drug Administration approved Ozempic to treat Type 2 diabetes in December 2017. Currently, there isn't a generic version of the drug, and there might not be for some time — Novo Nordisk’s Ozempic patents expire as late as December 2031, according to data from the FDA


Ozempic has gone viral for another purpose: weight loss. More people are searching Google for Ozempic than for ibuprofen, insulin or Viagra, according to Google Trends data for 2023

Google Trends. Interest Over Time. Accessed Feb 26, 2024.

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Medicare covers Ozempic for Type 2 diabetes

Medicare prescription drug plans might cover Ozempic, but only to treat diabetes.

In 2021, Medicare covered Ozempic for about 459,000 Medicare beneficiaries, according to data from the Centers for Medicare & Medicaid Services (CMS)

Centers for Medicare & Medicaid Services. Medicare Part D Spending by Drug. Accessed Feb 26, 2024.

Medicare spent over $2.6 billion to cover Ozempic in 2021, making it No. 10 for the highest total Medicare Part D spending, according to CMS data.

Because it’s an outpatient prescription drug, Ozempic falls under Medicare Part D. Coverage for Ozempic differs between plans.

If you have Original Medicare, you can buy a stand-alone Medicare Part D plan to get prescription drug coverage. If you have Medicare Advantage, most plans include prescription drug coverage. With Medicare Advantage, you cannot buy a separate Part D plan.

You’ll need to check your plan’s formulary to confirm if and how the plan covers Ozempic.

Will Medicare pay for Ozempic for weight loss?

Over 40% of U.S. adults age 60 and older are considered obese, according to 2017-2020 data from the Centers for Disease Control and Prevention


Despite the prevalence of obesity among older adults, Medicare won’t cover weight loss drugs. Medicare Part D plans are prohibited from covering drugs “used for anorexia, weight loss or weight gain (even if used for a non-cosmetic purpose (i.e., morbid obesity)),” according to the Medicare Prescription Drug Benefit Manual

Centers for Medicare & Medicaid Services . Medicare Prescription Drug Benefit Manual: Chapter 6. Accessed Feb 26, 2024.

That means unless you have another source of coverage, you’d need to pay out of pocket for an Ozempic (semaglutide) prescription for weight loss.

Does Medicare cover Wegovy?

In June 2021, the FDA approved another semaglutide product for weight loss. Novo Nordisk sells semaglutide for weight loss under the brand name Wegovy.

But FDA approval doesn’t guarantee Medicare coverage. As with Ozempic, Medicare doesn’t cover Wegovy as a prescription for weight loss.

Does Medicare cover Mounjaro (or Zepbound)?

Mounjaro is the brand name for tirzepatide approved as a treatment for type 2 diabetes. And like Ozempic has Wegovy, Mounjaro has a more recently approved variant specifically for weight loss. That version of tirzepatide is branded Zepbound, and it was approved for weight loss in November 2023

Food and Drug Administration. FDA Approves New Medication for Chronic Weight Management. Accessed Feb 26, 2024.

As with Ozempic and Wegovy, Medicare won’t cover Mounjaro or Zepbound for weight loss.

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What you’d pay out of pocket for Ozempic, Wegovy, Mounjaro or Zepbound

Novo Nordisk’s list price for Ozempic is $935.77 per four weekly doses

Novo Nordisk. Find Out the Cost for Ozempic. Accessed Feb 26, 2024.
. For a full year, that would be nearly $12,200.

The list price for Wegovy is $1,349.02 per four weekly doses

. For a full year, that would be slightly more than $17,500.

Mounjaro and Zepbound have nearly identical list prices: $1,069.08 and $1,059.87 per four weekly doses, respectively

Eli Lilly. Pharmaceutical Product Prices. Accessed Feb 26, 2024.
. For a full year, that would be a little less than $14,000.

Because Ozempic, Wegovy, Mounjaro and Zepbound are still under patent protection, there’s no option to buy a cheaper generic version.

Covering weight loss drugs would be costly for Medicare

Policy change would be required for Medicare to start covering weight loss drugs. Legislation to allow coverage has been introduced in each of the past seven congressional terms but never passed.

The high costs of weight loss drugs might be one barrier to change. For example, if 10% of Medicare beneficiaries with obesity took Wegovy, it would cost Medicare Part D about $26.8 billion per year, according to estimates published by researchers at the Vanderbilt University School of Medicine and the University of Chicago Department of Medicine in the New England Journal of Medicine in March 2023


For reference, the prescription drug with the highest total Medicare Part D spending is Eliquis, an anti-stroke drug. Total Medicare Part D spending for Eliquis was nearly $12.6 billion in 2021, according to the most recent annual data available from CMS.

The estimated $26.8 billion to cover Wegovy would be more than twice that amount, or about one-eighth of the approximately $216 billion spent for all covered Medicare Part D drugs in 2021.

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