Does Medicare cover weight loss drugs? (Feb 2026)

Last updated: Feb 3, 2026

If you’re trying to figure out does Medicare cover weight loss drugs, the frustrating-but-accurate answer is:

• In most cases, no—Medicare Part D does not cover medications when they’re prescribed specifically for weight loss. Medicare Part D rules generally exclude “agents when used for anorexia, weight loss, or weight gain.” (CMS: Part D Excluded Drugs guidance (PDF))
• That exclusion is based in federal law. Part D’s covered-drug definition incorporates drug-class restrictions from the Medicaid drug statute, including “agents when used for anorexia, weight loss, or weight gain.” (Primary statute text: 42 U.S.C. § 1396r-8 (OLRC / uscode.house.gov))
• Medicare can sometimes cover some of the same medications—but only for a non-excluded use. Practically, that means you must (1) meet the drug’s specific FDA-labeled (or otherwise medically accepted) indication and (2) meet your plan’s coverage criteria (often prior authorization).
  • Important: “medically accepted” only helps within Part D’s covered drug categories—it does not override statutory exclusions (including the weight-loss exclusion). (CMS explains excluded categories and excluded uses in its Excluded Drug Reference File FAQ (PDF).)
• Even when a drug is eligible for Part D coverage, your plan may not cover it, or it may require prior authorization, step therapy, or quantity limits.

This guide explains the current rules and a practical workflow to confirm coverage with your plan. It also flags CMS-announced models and demonstrations that may change access in the future—but those details are not guaranteed and can vary by participating plans and eligibility.

This article is general education only—not legal, financial, or medical advice. Medicare rules and plan formularies change. For your specific situation, confirm details with your Part D plan and your clinician.

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Quick definitions (so the rest makes sense)

• Original Medicare = Part A (hospital) + Part B (medical/outpatient).
• Medicare Advantage (Part C) = private plan that bundles Part A and Part B, and often includes Part D drug coverage.
• Medicare Part D = outpatient prescription drug coverage (run by private plans).
• Formulary = your plan’s list of covered drugs and the rules for getting them.
• Medically accepted indication = a use that Part D can cover.
  • Most often, this matches the drug’s FDA labeling.
  • In some cases, it can include certain non-labeled (“off-label”) uses if they’re supported by approved drug compendia (recognized reference lists used in coverage decisions).
  • Key limitation: compendia support does not override Part D’s statutory exclusions—so it doesn’t turn an excluded weight-loss use into a covered use. (See CMS’s discussion in the Part D manual, Ch. 6 (PDF).)

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Why Medicare usually doesn’t cover weight loss drugs

Medicare Part D doesn’t cover every prescription category. One of the excluded categories is agents when used for weight loss.

That’s why many beneficiaries hear some version of: “Medicare doesn’t cover weight loss meds.”

The key nuance: the use matters

Some drugs that are famous for weight loss (especially GLP-1 receptor agonists, a class of medicines that affect appetite and blood sugar) can also have FDA-approved indications for other conditions.

You may also hear about “GLP-1/GIP” drugs. That’s mainly a naming/class difference (some drugs target both gut-hormone pathways)—it’s not a Medicare coverage rule by itself.

CMS explains that a drug can be treated as “excluded” for one use but still be eligible for coverage for another FDA-labeled indication, depending on the circumstance and plan design. (See the CMS excluded-drug FAQ linked in the introduction.)

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Medicare Part B vs. Part D for weight management: what’s covered

Most weight-loss medications used at home are handled under Part D. But Medicare does cover some evidence-based weight-management services under Part B.

Covered: Intensive Behavioral Therapy (IBT) for obesity (Part B)

Medicare covers Intensive Behavioral Therapy (IBT) for obesity when:

• Your BMI is 30 kg/m² or higher, and
• A qualified primary care practitioner provides it in a primary care setting

Official sources: Medicare.gov obesity behavioral therapy coverage and CMS NCD 210.12.

Sometimes covered: Bariatric surgery (when criteria are met)

Medicare’s national coverage policy describes coverage for certain bariatric procedures when the beneficiary has:

• BMI ≥ 35 kg/m²
• At least one obesity-related comorbidity
• Unsuccessful prior medical treatment for obesity

(CMS NCD 100.1: Bariatric Surgery)

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Which “weight loss drugs” are people usually asking about?

Most searches for “does Medicare cover weight loss drugs” are really about GLP-1 medications (and related drugs).

The confusion usually comes from brand-name pairs where the molecule (or drug family) is similar, but the FDA-labeled indication differs.

Mini-table: common brand names and why Medicare coverage differs

These are simplified, non-exhaustive label summaries meant to explain why coverage differs. For coverage decisions, confirm the full FDA indication and your plan’s formulary/prior authorization criteria.

Example: Wegovy and the cardiovascular indication

On March 8, 2024, the FDA announced approval of a new indication for Wegovy (semaglutide) to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and obesity/overweight, alongside diet and physical activity. (FDA press announcement)

For context on why that matters for Medicare coverage pathways, see: KFF on Wegovy’s cardiovascular indication and Medicare coverage pathway.

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Coverage reality check: “Eligible for Part D” ≠ “My plan covers it”

Even when a medication is eligible for Part D coverage, your specific plan may:

• not include it on the formulary
• place it on a high-cost tier
• require prior authorization or step therapy

Also, some plans offer additional (enhanced) coverage beyond the standard Part D benefit—so two people on “Medicare” can have very different drug coverage.

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A simple decision tree: does Medicare cover your weight loss medication?

Step 1: Is the drug being prescribed for weight loss only?

• Yes → in general, Part D won’t cover it due to the weight-loss exclusion.
• No / it’s for another FDA-approved condition → go to Step 2.

Step 2: Does your situation match a specific FDA-labeled indication that Part D can cover?

Examples:

• Type 2 diabetes (for drugs labeled for T2D, such as Ozempic or Mounjaro)
• A specific cardiovascular risk-reduction indication listed on the FDA label (for example, Wegovy’s labeled indication for adults with established cardiovascular disease and obesity/overweight)

Then check your plan’s prior authorization criteria, because plans can still limit coverage even for FDA-labeled uses.

Step 3: Is the medication on your plan’s formulary for that use, and do you meet the plan’s criteria?

• Yes → likely covered, but expect possible prior authorization.
• No → request a formulary exception or consider plan changes during the next enrollment window.

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How to check coverage (fastest, least-confusing workflow)

1) Use the official Medicare Plan Finder to compare Part D options

Medicare’s Plan Finder lets you enter your ZIP code, add your drugs and pharmacies, and compare estimated costs across plans: Medicare Plan Finder (Plan Compare).

2) Find your plan’s formulary and search by drug name

Look for:

• Tier (helps predict copay vs coinsurance)
• PA (prior authorization), ST (step therapy), QL (quantity limits)
• Notes about what diagnosis/indication is required

3) Call your plan and ask these exact questions

Copy/paste script:

1. Is [drug name] on my formulary?
2. What tier is it on?
3. Do you require prior authorization? Step therapy? Quantity limits?
4. Is coverage limited to specific diagnoses/indications?
5. What will I pay before and after my deductible?
6. If it’s not covered, what’s the process for a formulary exception and an appeal?

If you want more step-by-step help with PA and appeals workflows, these guides go deeper:

• Wegovy insurance: coverage, cost, and appeals
• Zepbound insurance coverage: costs & prior authorization

4) If prior authorization is required, ask for the written criteria

Your goal is to get a document you can share with the prescribing office so they submit the right evidence the first time.

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What documentation typically helps with prior authorization (PA)

Every plan is different, but these items commonly speed up review:

• a clear diagnosis/indication (the “why”)
• relevant clinical history (for example, previous medication trials)
• the exact drug, dose, and directions
• chart notes that align with the plan’s criteria

If you’re a caregiver helping a parent, a simple way to reduce back-and-forth is to keep a one-page “coverage packet” that includes:

• the plan name and member ID
• the plan’s formulary listing (screenshot)
• the PA criteria document (if you got it)
• the pharmacy name and phone/fax
• the prescriber’s clinic contact

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What about new CMS models and pilots for GLP-1 access?

CMS has announced models/demonstrations intended to improve access and affordability for GLP-1 medications, but these are not the same as current Part D coverage.

Key caveats: participation is voluntary, and details like eligibility rules, participating plans/regions, covered drugs, and final patient cost can change as CMS publishes more guidance.

1) BALANCE Model (announced timeline; voluntary)

As of the “Last updated” date at the top of this article, CMS describes the BALANCE Model start dates as:

• Medicaid: May 2026
• Medicare Part D: January 2027

(See: CMS BALANCE Model overview page and CMS BALANCE Model RFA (PDF).)

2) Medicare GLP-1 payment demonstration (announced; proposed, not current coverage)

CMS also describes a planned Medicare GLP-1 payment demonstration beginning July 2026.

Important: This is not current Medicare coverage, and it is not a Medicare-wide $50/month benefit.

According to CMS’s announcement, if this demonstration is implemented and you’re eligible in a participating program, beneficiaries would pay $50 per month for the GLP-1 drugs included in the demonstration. CMS also says more details would be released in early 2026—so specifics could change as formal guidance is published. (Source: CMS press release on BALANCE and the GLP-1 payment demonstration.)

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If the answer is “no,” what can you do under Medicare?

Option 1: Use Part B’s obesity behavioral therapy benefit

If you have BMI ≥ 30, ask your primary care clinician about Intensive Behavioral Therapy for obesity and whether it’s available in their practice setting.

Option 2: Re-check whether you qualify under a different (covered) indication

This is clinician-led—not a DIY hack.

Coverage requires an accurate diagnosis and documentation that matches the medical record and the drug’s FDA labeling/medically accepted indication. Don’t ask a clinician to “code” a diagnosis you don’t have.

Option 3: Consider a plan change (at the right time)

If a drug is crucial for a covered indication, a different Part D plan (or Medicare Advantage plan with drug coverage) may cover it differently.

If you’re working on lifestyle changes while you sort out coverage, it can also help to understand the difference between scale weight and body fat change: Fat loss vs weight loss: key differences & tracking methods.

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FAQ: Medicare coverage for weight loss medications

Does Medicare cover Ozempic for weight loss?

In general, Medicare Part D does not cover medications when used specifically for weight loss.

Important: Ozempic is FDA-approved for type 2 diabetes (and certain risk-reduction uses in adults with T2D), not as a weight-loss drug. (See the FDA Ozempic label linked in the table above.)

So if Ozempic is covered under your plan, it’s typically because the documented use matches a covered, FDA-labeled indication (such as type 2 diabetes)—and your plan’s formulary/prior authorization criteria are met.

Does Medicare cover Wegovy?

For weight loss alone, Part D generally can’t cover it.

But because Wegovy also has an FDA-approved cardiovascular risk-reduction indication, Part D coverage may be possible for that use depending on your plan’s formulary and prior authorization criteria. (FDA press announcement)

Do Medicare Advantage plans cover weight loss drugs differently than Part D?

Medicare Advantage plans that include drug coverage (often called MA-PD plans) still provide prescription coverage through the Part D benefit—so the same weight-loss exclusion generally applies.

What can differ by plan is the formulary, tiering, and utilization management (prior authorization, step therapy, and quantity limits). The most reliable way to verify is still to check the plan’s formulary and use the Medicare Plan Finder.

Are any “anti-obesity medications” covered by Medicare?

As a broad category, anti-obesity medications are generally excluded from Part D when used for weight loss. But some medications in this space are eligible for coverage for other FDA-approved uses.

ASPE notes that Medicare Part D enrollees currently have access to some GLP-1 receptor agonists for indications other than obesity, and it reviewed a proposed CMS reinterpretation that could expand access for obesity treatment. (ASPE: Medicare Coverage of Anti-Obesity Medications; ASPE issue brief (PDF))

Does Medicare cover weight-loss programs?

Yes—Medicare covers Intensive Behavioral Therapy for obesity (counseling) for people with BMI ≥ 30, when provided in a primary care setting. (Official sources linked earlier in the Part B section.)

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Bottom line

If you’re researching does Medicare cover weight loss drugs, remember:

1. Part D generally excludes drugs used for weight loss. (CMS excluded-drugs guidance linked above; statutory restriction in 42 U.S.C. § 1396r-8.)
2. The same drug may be eligible for coverage for a different FDA-approved indication (like type 2 diabetes or a specific labeled cardiovascular indication), depending on your plan.
3. Your plan’s formulary and prior authorization rules decide what happens next.

If you’re stuck, the most productive move is usually: get the plan’s written PA criteria → share it with the prescriber → resubmit cleanly or request an exception/appeal.