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Are anti-obesity medications covered by Medicare?

In 2003 Congress passed a Rule that distinctly prohibited Medicare Part D prescription drug benefits from covering drugs used for weight loss, along with some other types of drugs, including agents used for cosmetic purposes or hair growth, fertility drugs, and drugs prescribed to treat sexual or erectile dysfunction.  

Originally approved to treat type 2 diabetes, prescription drugs known as GLP-1 (glucagon-like peptide-1) agonists, including Novo Nordisk’s Ozempic and Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide), are also often effective for weight loss. But they are also expensive, and not covered by Medicare when used for weight loss. However, if the same drug receives FDA approval for a medically accepted use such as cardiovascular disease or type 2 diabetes, it may be covered by Medicare prescription drug plans.

Wegovy’s label was approved to include cardiovascular benefits. As long as it is prescribed to reduce their risk of heart attack and stroke it may be covered. If Ozempic is prescribed to control type 2 diabetes, then it also may be covered under Medicare Part D as well. Mounjaro might not yet be covered. 

Your best bet is to call your insurance carrier and ask directly if your prescribed drug is included in their formulary (a list of drugs covered by the plan) and how much it will cost you out-of-pocket. In addition, Part D plans may require enrollees to get advance approval (prior authorization) from the plan so make sure to also ask about that.

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