Does Medicare Cover Ozempic?
Medicare covers Ozempic as a treatment for diabetes, but not for weight loss.
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Medicare Part D covers Ozempic to treat diabetes, but not as a weight loss treatment.
Similarly, Medicare covers Wegovy as a treatment to reduce the risk of certain serious cardiovascular events, but not for weight loss.
Medicare doesn’t cover any drug for weight loss alone.
Medicare doesn’t cover Ozempic for weight loss, but it does cover it for diabetes treatment. In fact, Medicare can’t cover Ozempic, Wegovy, Zepbound, Mounjaro or any prescription drugs for weight loss. And because of legal barriers and cost, 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 searched Google for Ozempic than for ibuprofen, insulin or Viagra in 2024, according to Google Trends data.
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Does Medicare pay for Ozempic?
Medicare prescription drug plans might cover Ozempic, but only to treat diabetes.
Does Medicare cover Ozempic for diabetes?
Yes. Medicare prescription drug plans can cover Ozempic for diabetes. In 2023, Medicare covered Ozempic for about 1.46 million people, according to data from the Centers for Medicare & Medicaid Services (CMS).
Ozempic falls under Medicare Part D because it’s an outpatient prescription drug. 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.
Does Medicare cover Ozempic for weight loss?
No. Medicare won’t pay for Ozempic as a prescription for weight loss. This is true even if you have prescription drug coverage through Medicare Part D or Medicare Advantage. Unless you have another source of coverage, you’d need to pay out of pocket for Ozempic for weight loss.
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.
How much does Ozempic cost?
Novo Nordisk’s list price for Ozempic is $997.58 per four weekly doses. For a full year, that would be nearly $13,000.
The cost of Ozempic could be considerably lower on Medicare if it’s prescribed to treat diabetes — as long as you have a Medicare Part D prescription drug plan that covers Ozempic. You would just need to pay a copay or coinsurance and possibly a deductible. Exact costs vary by plan.
Does Medicare cover weight loss drugs?
By law, Medicare can’t cover any drug used for weight loss alone. But “weight loss drugs” such as Ozempic, Wegovy and Mounjaro are sometimes prescribed for other purposes. Medicare plans might cover some of these drugs if they’re being prescribed to treat diabetes, cardiovascular disease or even sleep apnea.
Does Medicare cover Wegovy?
As with Ozempic, Medicare doesn’t cover Wegovy as a prescription for weight loss. However, CMS indicated that Medicare Part D can cover anti-obesity medications like Wegovy to “reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight” in guidance issued in March 2024.
In June 2021, the FDA approved Wegovy for weight loss. Novo Nordisk sells the semaglutide.
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 without coverage.
Does Medicare cover Mounjaro (or Zepbound)?
As with Ozempic and Wegovy, Medicare won’t cover Mounjaro or Zepbound for weight loss. However, Medicare Part D can cover Zepbound and Mounjaro as a treatment for Type 2 diabetes or cardiovascular disease. Medicare can also cover Zepbound for the treatment of sleep apnea.
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. Zepbound was also approved for sleep apnea in December 2024.
Mounjaro and Zepbound have nearly identical list prices: $1,079.77 and $1,086.37 per four weekly doses, respectively. For a full year, that would be a little over $14,000 without coverage.
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When will Medicare cover weight loss drugs?
It is unlikely that Medicare will cover Ozempic and other weight loss drugs in 2025. 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 Treat and Reduce Obesity Act of 2025, which would enable Medicare to cover weight loss drugs such as Ozempic, was introduced in both the House and the Senate in June. To become law, the bill would need to pass both the House and Senate and be signed by the president.
The high costs of weight loss drugs might be one barrier to change. Medicare spent roughly $9.2 billion to cover Ozempic in 2023, making it No. 2 for the highest total Medicare Part D spending, according to CMS data. Medicare spending on Ozempic nearly doubled from 2022 to 2023.
If Medicare were to cover these drugs for weight loss, spending would be even higher. 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 over $18 billion in 2023, according to the most recent annual data available from CMS.
The estimated $26.8 billion to cover Wegovy would be significantly more than that amount, or about one-ninth of the approximately $240 billion spent for all covered Medicare Part D drugs in 2022.
Help paying for Ozempic and other weight loss drugs on Medicare
Because Ozempic, Wegovy, Mounjaro and Zepbound are still under patent protection, there’s no option to buy a cheaper generic version. That doesn’t leave you without options though, even if Medicare doesn’t cover your prescription.
If you’re prescribed one of these drugs for diabetes or cardiovascular disease, consider looking for a plan with good coverage for the drug during Medicare open enrollment. Medicare.gov and shopping tools from many insurance companies and brokers can show how plans would cover specific drugs.
If you’re looking to take Ozempic or other weight loss drugs for weight loss alone, you can always talk to your doctor about more affordable treatment options.
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