Does Medicare Part D cover Ozempic?

Medicare Part D plans may cover Ozempic when prescribed for type 2 diabetes, as Ozempic is FDA-approved for this indication. Coverage varies by specific Part D plan, and the medication may be subject to prior authorization, step therapy requirements, and formulary tier placement. Contact your Part D plan directly to verify coverage and estimate your out-of-pocket costs.

Does Medicare cover Wegovy for weight loss?

Medicare coverage for anti-obesity medications like Wegovy has been evolving. Recent legislative changes have begun expanding Medicare's ability to cover medications prescribed for weight management. However, specific coverage details vary by Part D plan and continue to change. Check with your Part D plan or call 1-800-MEDICARE for the most current information about your coverage.

How much does GLP-1 medication cost with Medicare?

If a GLP-1 medication is covered under your Medicare Part D plan, your out-of-pocket cost depends on the plan's formulary tier, whether you have met your deductible, and your position in the coverage phases (initial coverage, coverage gap, catastrophic). The Inflation Reduction Act has capped annual out-of-pocket drug spending for Medicare beneficiaries. Contact your Part D plan for a personalized cost estimate.

Can I use manufacturer coupons with Medicare?

Generally, manufacturer copay cards and savings coupons cannot be used by Medicare beneficiaries. Federal anti-kickback laws restrict the use of manufacturer copay assistance for people enrolled in federal healthcare programs. However, some manufacturers offer separate patient assistance programs specifically for Medicare beneficiaries who meet income-based eligibility requirements. Contact the medication manufacturer directly to ask about available programs.

Medicare & GLP-1 Coverage — What's Covered in 2026

Medicare GLP-1 coverage is evolving

Medicare coverage for GLP-1 medications has been a rapidly changing area of healthcare policy. Historically, Medicare Part D was prohibited from covering medications prescribed solely for weight loss. However, the landscape has shifted significantly in recent years.

The Inflation Reduction Act and subsequent legislation have opened new pathways for Medicare to cover GLP-1 medications, particularly as the evidence base for these drugs' broader health benefits has grown. Coverage for GLP-1 medications prescribed for type 2 diabetes has been more established, while weight management coverage continues to expand.

Important

Medicare coverage rules change. The information on this page reflects publicly available information as of early 2026. Always verify current coverage with your specific Part D plan or by contacting Medicare directly.

What's currently covered

Coverage depends on the indication and your specific Part D plan.

Medicare Part D: diabetes

Medicare Part D plans may cover GLP-1 medications prescribed for type 2 diabetes management. This includes medications like Ozempic® and Mounjaro® when prescribed for their FDA-approved diabetes indications.

Coverage varies by specific Part D plan
May require prior authorization
Subject to formulary tier placement and copays
Step therapy requirements may apply

Weight management: expanding

Recent legislative changes have begun allowing Medicare to cover anti-obesity medications. This is a significant shift from historical policy that excluded weight loss drugs from Medicare coverage.

Coverage pathways are expanding through legislation
Specific coverage details vary and continue to evolve
Not all Part D plans may cover equally
Verify current coverage with your specific plan

Note

Coverage rules change frequently. The information above is based on publicly available policy information as of early 2026. Always verify current coverage directly with Medicare or your Part D plan.

How to check your Medicare coverage

Practical steps to find out if your Part D plan covers a specific GLP-1 medication.

1
Use the Medicare Plan Finder
Visit Medicare.gov and use the Plan Finder tool to look up your specific Part D plan's formulary. You can search by medication name to see if it is covered and what tier it falls on.
2
Call 1-800-MEDICARE (1-800-633-4227)
Medicare's helpline can provide information about Part D coverage policies and help you understand your specific plan's formulary. Representatives are available 24 hours a day, 7 days a week.
3
Contact your Part D plan directly
Call the customer service number on your Part D plan card. Ask specifically about the medication you're interested in, including tier placement, prior authorization requirements, and your estimated copay.
4
Ask your doctor's office
Your prescribing doctor's office may be able to help check your coverage and submit prior authorization paperwork. Many offices have staff who specialize in navigating Medicare coverage for specialty medications.

Cost under Medicare

If a GLP-1 medication is covered, your cost depends on several factors.

Part D deductible

You may need to meet your annual Part D deductible before coverage kicks in. The standard deductible amount is set by Medicare each year.

Formulary tier

Your copay depends on which tier the medication falls on in your plan's formulary. Higher tiers generally mean higher copays or coinsurance.

Coverage gap

The Medicare coverage gap (donut hole) may affect your costs. The Inflation Reduction Act has been reducing out-of-pocket costs in the coverage gap.

Out-of-pocket cap

The Inflation Reduction Act established an annual out-of-pocket spending cap for Medicare Part D beneficiaries, providing protection against catastrophic drug costs.

Important

Manufacturer copay assistance cards generally cannot be used by Medicare beneficiaries due to federal anti-kickback regulations. Some manufacturers offer separate patient assistance programs for Medicare beneficiaries who meet income requirements.

Resources

Official resources for Medicare beneficiaries.

Medicare.gov

The official Medicare website where you can use the Plan Finder tool to check your Part D plan's formulary, compare plans, and find coverage information.

Medicare.gov

1-800-MEDICARE (1-800-633-4227)

Medicare's official helpline available 24/7. Representatives can help you understand your coverage options and answer questions about specific medications.

Call 1-800-633-4227

State Health Insurance Assistance Program (SHIP)

SHIP provides free, personalized counseling for Medicare beneficiaries. Trained counselors can help you navigate Part D coverage, compare plans, and understand your options.

Contact your state SHIP program

Benefits.gov

A federal resource to help you find government benefits programs, including Medicare-related assistance programs that may help with prescription drug costs.