Medicare provides health insurance to millions of older adults and certain younger people with disabilities. Diet drugs—also called anti-obesity medications or weight-loss injections—are a common question because obesity affects many beneficiaries and these drugs can be very expensive. Coverage rules depend heavily on federal law, the specific drug, and the medical diagnosis.
Under current Medicare policy, most prescription diet drugs are not covered when used only to treat obesity or promote weight loss. This exclusion comes from a long-standing provision in the Social Security Act that classifies such medications as “cosmetic” or “lifestyle” rather than medically necessary in most cases. Coverage is allowed only when the drug treats another covered condition, such as type 2 diabetes.
This article explains the current Medicare rules for diet drugs in 2025, which plans may cover them, what the out-of-pocket costs look like, recent pilot programs, and practical alternatives for people who want these treatments. The information reflects official CMS guidance and major plan policies as of mid-2025.
Medicare’s Official Policy on Diet Drugs
Medicare Part D (prescription drug plans) follows federal law that excludes “drugs when used for anorexia, weight gain, or weight loss” unless they treat another medically accepted condition. This rule has been in place since the Medicare Modernization Act of 2003 and remains unchanged in 2025.
Ozempic and Mounjaro (semaglutide and tirzepatide) are covered under Part D when prescribed for type 2 diabetes because improving glycemic control is a recognized medical use. Wegovy and Zepbound are not covered when the only purpose is weight loss, even if obesity contributes to diabetes, heart disease, or joint problems.
The exclusion applies to all Part D plans, including standalone PDPs and Medicare Advantage plans with drug coverage (MA-PD). Medicare Supplement (Medigap) policies do not cover prescriptions at all.
Coverage for Diabetes vs Weight Loss Only
When a doctor prescribes Ozempic or Mounjaro for type 2 diabetes, most Part D plans cover the drug after prior authorization. Patients pay copays or coinsurance based on the plan’s formulary tier—often Tier 3 or specialty tier. With Extra Help (Low-Income Subsidy), costs drop to $4–$11 per prescription.
Wegovy and Zepbound are excluded from Part D when used solely for chronic weight management. Even if obesity worsens diabetes or hypertension, coverage is denied unless the primary diagnosis is diabetes and the drug is billed under that indication. Off-label use for weight loss is not covered.
Medicare Advantage plans follow the same exclusion for weight-loss-only use. Some Advantage plans offer extra benefits like gym memberships or over-the-counter allowances, but none cover Wegovy or Zepbound for obesity alone in 2025.
- Coverage Summary by Indication:
- Type 2 diabetes: Usually covered (Ozempic/Mounjaro)
- Obesity/weight loss only: Not covered (Wegovy/Zepbound)
- Prior authorization: Required for diabetes use
- Step therapy: Often required before approval
Medicare Pilot Programs for Obesity Drugs
In early 2025, Medicare launched limited voluntary pilot programs to test coverage of anti-obesity medications in select regions. These pilots include negotiated prices for Wegovy and Zepbound, with copays as low as $50 per month for participating beneficiaries. The pilots are designed to gather data on whether covering these drugs reduces long-term costs for obesity-related conditions.
Enrollment is voluntary and restricted to specific geographic areas and plan types. Not all Medicare beneficiaries can participate, and the pilots do not represent nationwide policy. If successful, broader coverage could begin in 2027 or later.
Until then, the vast majority of Medicare Part D plans continue to exclude Wegovy and Zepbound when used only for weight loss. Check with your plan or Medicare.gov for availability in your area.
Typical Out-of-Pocket Costs Without Coverage
Without coverage, the cash price for Wegovy or Zepbound is approximately $1,300–$1,400 per month at retail pharmacies in 2025. Ozempic and Mounjaro cash prices fall in the same range ($1,050–$1,350 per pen). Annual costs exceed $15,000 without assistance.
Discount cards like GoodRx, SingleCare, RxSaver, and Blink Health reduce cash prices to $900–$1,100 per month at participating pharmacies. These cards are widely accepted and do not require insurance.
Manufacturer patient assistance programs provide free medication to uninsured patients who meet income guidelines (usually ≤400% of the federal poverty level). Approval requires proof of income and prescription. Processing takes 2–6 weeks.
Comparison of Monthly Costs by Coverage Scenario
| Coverage Scenario | Typical Monthly Cost (USD) | Includes Doctor Visits? | FDA-Approved Product? |
|---|---|---|---|
| Medicare Part D (diabetes only) | $0–$100 (Extra Help) or $200–$600 | No | Yes |
| Medicare pilot program (select regions) | ~$50 | No | Yes |
| Uninsured + manufacturer PAP | $0 | No | Yes |
| Uninsured + compounded telehealth | $199–$499 | Yes | No |
| Cash pay branded (discount card) | $900–$1,100 | No | Yes |
Compounded telehealth programs currently offer the lowest predictable monthly cost with medical oversight for uninsured patients.
Manufacturer and Patient Assistance Programs
Novo Nordisk (Ozempic/Wegovy) and Eli Lilly (Mounjaro/Zepbound) offer patient assistance programs that provide free medication to qualifying uninsured or underinsured individuals. Eligibility generally requires household income at or below 400% of the federal poverty level and proof that other coverage options have been denied.
Applications are submitted online or through a healthcare provider. Required documents include recent tax returns, proof of income, denial letters from insurance (if applicable), and a valid prescription. Approval can take 2–6 weeks, but once approved the medication ships directly at no cost for 12 months (renewable).
These programs do not cover office visits, lab work, or supplies. Patients must still see a licensed prescriber willing to complete the paperwork and monitor treatment.
Compounded GLP-1 Options for Uninsured Patients
Compounded semaglutide and tirzepatide from licensed telehealth providers offer the lowest out-of-pocket costs for uninsured patients in 2025. Reputable platforms charge $199–$499 per month (all-inclusive) for doses up to the maximum approved strength. The fee typically covers virtual consultation, prescription, medication vials/syringes, shipping, and messaging support.
Popular providers include Henry Meds, Lavender Sky Health, OrderlyMeds, Eden, Mochi Health, and Sesame Care. Many use 503B outsourcing facilities that follow stricter manufacturing standards. Monthly pricing often remains flat regardless of dose.
Compounded versions are not FDA-approved, so quality depends on the pharmacy. Reputable programs provide third-party sterility and potency testing results for each batch. Avoid companies that sell “research peptides” or ship without physician review.
Practical Steps to Explore Coverage or Lower Costs
- Log in to your Medicare plan portal or call the number on your card to review the formulary and prior authorization criteria for Ozempic/Mounjaro.
- If you have type 2 diabetes, ask your doctor to submit a prior authorization request for diabetes coverage.
- If denied for weight loss, appeal with medical documentation of comorbidities.
- Apply for manufacturer patient assistance if uninsured or income-qualified.
- Compare compounded telehealth quotes from 3–5 reputable providers if branded coverage is unavailable.
- Use discount cards (GoodRx, SingleCare) for the lowest cash price on branded product if needed.
Safety and Monitoring Considerations
All GLP-1 medications carry similar gastrointestinal side effects (nausea, vomiting, diarrhea, constipation) that are most intense during dose escalation. These usually improve after 4–8 weeks. Rare serious risks include pancreatitis, gallbladder problems, and thyroid concerns (seen in animal studies).
Regular follow-up with your prescriber is essential. Blood work (A1C, kidney function, lipids) is recommended every 3–6 months. Monitor for severe abdominal pain, persistent vomiting, or signs of dehydration.
Weight loss injections are powerful tools but require medical supervision. Never start, stop, or adjust doses without guidance from a licensed provider.
Medicare does not cover weight loss injections like Wegovy or Zepbound when used only for obesity in 2025, though limited pilot programs test coverage in select regions. Commercial plans offer the best chance of affordable access with prior authorization and savings cards. Compounded telehealth options provide the lowest out-of-pocket costs for uninsured patients. Work closely with your doctor and insurance plan to explore every available path to safe, effective treatment.
FAQ
Does Medicare cover Wegovy or Zepbound for weight loss?
No. Medicare Part D excludes coverage for drugs used only for weight loss or obesity under current federal law. Ozempic and Mounjaro are covered when prescribed for type 2 diabetes.
Are there any 2025 pilot programs that cover weight loss injections under Medicare?
Yes. Limited voluntary pilot programs in select regions test coverage of Wegovy and Zepbound at reduced copays (around $50/month). These pilots are not nationwide and enrollment is restricted.
What is the cash price for Wegovy or Zepbound without insurance?
The cash price for a 4-week supply of branded Wegovy or Zepbound is typically $1,300–$1,400 at retail pharmacies in 2025. Discount cards can reduce it to $900–$1,100 per month at participating locations.
Can I get Wegovy or Zepbound free without insurance?
Yes. Manufacturer patient assistance programs from Novo Nordisk and Eli Lilly provide free branded medication to uninsured or underinsured patients who meet income guidelines (usually ≤400% of the federal poverty level). Approval requires financial documentation and takes 2–6 weeks.
Are compounded GLP-1 injections a safe low-cost alternative?
Compounded versions cost $199–$499 per month through telehealth but are not FDA-approved. Choose providers using 503B pharmacies with third-party testing for sterility and potency. Avoid “research peptides” or sources without physician oversight.
What should I do if my Medicare plan denies coverage for diabetes use?
Appeal the denial with medical documentation of type 2 diabetes diagnosis and medical necessity. Ask your doctor to submit a prior authorization or letter of medical necessity. If denied, explore manufacturer assistance or compounded options.
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.