Semaglutide is a popular medication known for helping manage type 2 diabetes and supporting weight loss. It comes in forms like Ozempic for diabetes control and Wegovy for chronic weight management. Many military families and veterans rely on TRICARE for their healthcare needs, including prescriptions. Questions about coverage often arise due to changing policies and specific plan rules.
TRICARE, the health program for uniformed service members, retirees, and their families, handles pharmacy benefits through Express Scripts. Coverage for semaglutide depends on the diagnosis, your TRICARE plan, and whether prior authorization is met. Recent updates, especially from August 2025, have tightened rules for weight loss uses while keeping diabetes treatment supported. This ensures resources align with medical necessity.
In this article, we break down current TRICARE coverage for semaglutide in 2026. We’ll cover differences between diabetes and weight loss indications, plan variations, requirements, and practical steps. The goal is to provide clear guidance so you can discuss options confidently with your provider.
How Semaglutide Fits into TRICARE Benefits
Semaglutide works as a GLP-1 receptor agonist, mimicking a hormone that regulates blood sugar and appetite. For diabetes, it improves glycemic control and reduces risks like heart events. Wegovy, with higher dosing, targets long-term weight management in those with obesity or related conditions. TRICARE follows FDA approvals closely when deciding coverage.
The program covers many GLP-1 drugs when prescribed appropriately. Ozempic (semaglutide injection) remains available for type 2 diabetes across eligible plans. Wegovy sees coverage limited to specific groups for weight purposes. Changes aim to balance access with federal guidelines on non-essential treatments.
Always check the latest through official channels, as policies evolve. Your military treatment facility or network provider plays a key role in navigating approvals. This keeps treatments safe and evidence-based.
Coverage for Diabetes Treatment
TRICARE continues to cover semaglutide for type 2 diabetes when medically necessary. Drugs like Ozempic, along with similar options such as Trulicity, Victoza, and Mounjaro, qualify under this category. Prior authorization is required to confirm diagnosis and need. This applies broadly, including to TRICARE For Life beneficiaries.
Providers submit forms showing blood sugar levels and other factors. Once approved, you fill prescriptions at military pharmacies, network locations, or home delivery. Copays stay consistent, often lower for formulary items. This support helps manage chronic conditions effectively without major barriers.
No major shifts occurred here post-2025 updates. Diabetes coverage remains stable to prioritize health outcomes. If you have type 2 diabetes, discuss semaglutide with your doctor for potential approval.
Coverage for Weight Management
For weight loss, TRICARE covers Wegovy (semaglutide) under stricter conditions. It applies mainly to TRICARE Prime and Select plans, requiring prior authorization. You need a BMI of 30 or higher, or 27 with comorbidities like hypertension or sleep apnea. Step therapy or documented lifestyle efforts may factor in.
Changes effective August 31, 2025, ended coverage for weight loss drugs in TRICARE For Life and certain other groups. Those with direct care only or non-Prime/Select plans now pay full price for these uses. Existing approvals for weight loss expired, needing reevaluation.
Ozempic isn’t covered for weight loss alone, as it’s approved for diabetes. Off-label use rarely gets approval. Focus stays on approved indications to meet regulatory standards.
Key Requirements and Prior Authorization Process
Prior authorization ensures the medication matches your health needs. Your provider completes forms detailing diagnosis, BMI, and past treatments. Submit through Express Scripts for review. Approval lasts up to 12 months, with renewals possible.
Forms are available on the TRICARE site or Express Scripts portal. Include lab results or notes on diet and exercise attempts. This step prevents unnecessary use while supporting valid cases. Delays can occur, so start early.
If denied, appeal options exist. Provide more documentation or alternative rationale. Many succeed with thorough provider support.
Comparison of Semaglutide Coverage by Indication and Plan
| Indication | Covered Plans (2026) | Key Requirements | Notes on Changes |
|---|---|---|---|
| Type 2 Diabetes (Ozempic) | All eligible TRICARE plans, including TFL | Prior authorization, medical necessity | Stable coverage, no major restrictions |
| Chronic Weight Management (Wegovy) | TRICARE Prime and Select only | BMI criteria, prior auth, step therapy | Limited to Prime/Select; TFL excluded since Aug 2025 |
| Off-Label Weight Loss (Ozempic) | Generally not covered | Rarely approved without diabetes dx | Not FDA-approved for this use alone |
| Alternatives (e.g., Zepbound) | Similar to Wegovy for Prime/Select | Prior authorization required | Coverage mirrors weight management rules |
This table summarizes main differences to help compare options quickly.
Tips for Navigating TRICARE Coverage
Getting the most from your benefits involves proactive steps. These suggestions simplify the process.
- Talk to Your Provider Early: Share your goals and ask about semaglutide suitability. They handle prior authorization details.
- Use the Formulary Tool: Search Express Scripts’ TRICARE formulary online for real-time status and forms.
- Explore Home Delivery: Opt for 90-day supplies through Express Scripts to lower copays when approved.
- Track Documentation: Keep records of BMI, labs, and lifestyle changes to strengthen requests.
- Check Patient Assistance: Manufacturer programs may help if coverage falls short for eligible users.
- Stay Updated: Monitor TRICARE newsroom for policy shifts affecting your plan.
Following these keeps things straightforward.
Potential Side Effects to Discuss with Your Doctor
Semaglutide can bring side effects, especially when starting. Knowing them aids better management.
- Nausea and Vomiting: Common initially; eat small meals and avoid fatty foods to ease.
- Diarrhea or Constipation: Hydrate well and add fiber gradually for relief.
- Abdominal Pain: Usually mild; report severe or ongoing issues promptly.
- Headache or Fatigue: Often tied to dehydration or calorie changes; rest and fluids help.
- Low Blood Sugar Risk: More likely with diabetes meds; monitor levels closely.
Most improve over time. Your provider can adjust dosing or suggest remedies.
Conclusion
TRICARE provides solid support for semaglutide in type 2 diabetes treatment across plans, with Wegovy available for weight management under Prime and Select with proper approvals. Recent restrictions highlight the importance of medical necessity and plan specifics. By working closely with your healthcare team and following authorization steps, you can access this effective option where it fits your needs. Always verify details through official sources for the most accurate guidance.
FAQ
Does TRICARE Cover Ozempic for Diabetes?
Yes, TRICARE covers Ozempic for type 2 diabetes with prior authorization. It requires proof of medical necessity and often a completed form from your provider. This applies to most plans, including TRICARE For Life. Coverage remains unchanged by 2025 updates.
Is Wegovy Covered by TRICARE for Weight Loss?
TRICARE covers Wegovy for chronic weight management only under Prime or Select plans. You need prior authorization, meeting BMI criteria and possibly step therapy. TRICARE For Life and other groups no longer cover it for this use since August 2025.
What If I Have TRICARE For Life?
TRICARE For Life no longer covers weight loss medications like Wegovy after 2025 changes. Diabetes uses of Ozempic stay covered with prior authorization. Beneficiaries pay full price for weight indications. Consult your provider for alternatives.
How Do I Get Prior Authorization for Semaglutide?
Your TRICARE provider submits the form to Express Scripts with clinical details. Include diagnosis, BMI, and supporting records. Use the formulary search tool for the correct form. Approval reviews medical necessity before filling.
Can I Use Ozempic Off-Label for Weight Loss?
TRICARE generally does not cover Ozempic for weight loss without diabetes. It’s approved only for glycemic control. Off-label requests rarely succeed. Discuss Wegovy or other approved options if weight management is the goal.
Are There Copays for Covered Semaglutide?
Copays vary by plan and pharmacy option. Home delivery often offers lower costs for 90-day supplies. Military pharmacies may have minimal or no copay for formulary items. Check Express Scripts for your specific tier and amount.
What Alternatives Exist If Coverage Is Denied?
If semaglutide isn’t covered, consider other GLP-1s like Trulicity for diabetes. Lifestyle programs or older weight agents may qualify. Manufacturer savings cards help reduce costs. Your doctor can explore suitable substitutes based on your health.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.