Medicare provides health coverage for millions of older adults and certain younger people with disabilities. Weight loss injections, mainly GLP-1 drugs like semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro), have become very popular for treating obesity. Many Medicare beneficiaries ask whether these expensive injections are covered under their plan.
Current federal law treats most weight loss drugs as excluded from Medicare Part D coverage when used only for weight management. Coverage is allowed when the injection is prescribed for an approved medical condition such as type 2 diabetes. This distinction creates confusion and leaves many people paying full price out of pocket.
This article explains the current Medicare rules for weight loss injections in 2025. It covers what is and is not covered, recent pilot programs, practical costs, alternatives, and steps to explore coverage. Rules can change, so always check your specific plan or contact Medicare directly.
Current Medicare Coverage Rules for Weight Loss Injections
Medicare Part D (prescription drug plans) covers medications for approved medical conditions. Ozempic and Mounjaro are covered when prescribed for type 2 diabetes because improving blood sugar is an accepted medical use. Wegovy and Zepbound are not covered when the only purpose is weight loss.
The Social Security Act specifically excludes “drugs for anorexia, weight gain, or weight loss” unless they treat another covered condition. This law dates back to 2003 and still applies in 2025. Medicare does not cover Wegovy or Zepbound for obesity alone, even when a doctor documents medical necessity.
Coverage for diabetes use includes prior authorization in most plans. Step therapy is common, meaning patients must try metformin or other cheaper drugs first. Once approved, copays vary by plan tier and phase of coverage (deductible, initial coverage, coverage gap, catastrophic).
Diabetes vs Obesity Coverage Differences
When prescribed for type 2 diabetes, Ozempic and Mounjaro are usually covered under Part D. Patients pay copays or coinsurance based on the plan’s formulary tier. Extra Help (Low-Income Subsidy) reduces costs to $4–$11 per prescription for qualifying beneficiaries.
Wegovy and Zepbound are excluded from Part D when used only for weight management. Even if obesity contributes to diabetes or heart disease, 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 (Part C) follow the same rules as standalone Part D plans. Some Advantage plans offer extra benefits like fitness programs or over-the-counter allowances, but none cover weight-loss-only injections in 2025.
- Coverage Summary:
- Type 2 diabetes diagnosis: Usually covered (Ozempic/Mounjaro)
- Weight loss/obesity only: Not covered (Wegovy/Zepbound)
- Prior authorization: Required for diabetes use
- Step therapy: Often required before approval
Medicare Pilot Programs and Changes
In 2025, Medicare launched 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 limited and not available nationwide.
The pilots aim to gather data on whether covering these drugs reduces long-term costs for obesity-related conditions like diabetes and heart disease. If successful, broader coverage could begin in 2027 or later. Until then, most Medicare beneficiaries still face the full cash price for weight-loss-only use.
Part D plans in pilot regions may offer preferred access or lower copays for participants. Enrollment is voluntary and limited. 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 or SingleCare 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 offer the lowest predictable monthly cost with medical oversight for uninsured patients.
Manufacturer and Patient Assistance Programs
Novo Nordisk and Eli Lilly offer patient assistance programs that provide free branded medication to qualifying uninsured or underinsured individuals. Eligibility usually 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 to the patient or pharmacy 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 who is willing to complete the application paperwork and monitor treatment.
Compounded GLP-1 Options for Uninsured Patients
Compounded semaglutide and tirzepatide from licensed telehealth providers offer the lowest predictable monthly cost for uninsured patients in 2025. Reputable platforms charge $199–$499 per month for doses up to the maximum approved strength. The fee usually covers virtual consultation, prescription, medication, 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 stays flat regardless of dose, which benefits patients on higher maintenance strengths.
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 Access GLP-1 Medications Affordably
First, check eligibility for Novo Nordisk or Eli Lilly patient assistance programs if uninsured. Submit applications online or through your prescriber. If eligible, medication is free for 12 months.
If ineligible, compare cash prices using GoodRx, SingleCare, RxSaver, or Blink Health. These cards can reduce branded costs to $900–$1,100 per month at participating pharmacies.
Research 3–5 reputable telehealth compounded providers. Ask about pharmacy source, sterility testing, physician oversight, and total fees. Schedule a virtual consultation and share recent labs (A1C, kidney function, lipids).
Verify the provider is licensed in your state and uses a 503B facility. Read recent patient reviews on independent forums. Start at the lowest dose and titrate slowly to minimize side effects.
- Quick Access Checklist:
- Apply for manufacturer PAP if uninsured
- Compare cash prices with discount cards
- Research 3–5 telehealth compounded providers
- Verify 503B pharmacy and testing
- Schedule virtual consultation
- Track progress and side effects weekly
Safety and Legitimacy Considerations
Compounded GLP-1 medications are not FDA-approved, so purity, potency, sterility, and consistency are not federally guaranteed. Reputable providers use 503B outsourcing facilities and provide third-party testing results for each batch.
Avoid companies that sell “research-use-only” peptides, ship without a prescription, or advertise unrealistically low prices ($99/month or less) without physician involvement. These sources carry higher risks of contamination, incorrect dosing, or lack of active ingredient.
Branded medications have the strongest safety profile and consistent quality control. If affordability is the only barrier, prioritize manufacturer patient assistance or discount cards for the FDA-approved product whenever possible.
GLP-1 weight loss injections are covered by Medicare only when prescribed for type 2 diabetes. Obesity-only use remains excluded under current federal law. Compounded telehealth programs offer the lowest monthly costs ($199–$499) for uninsured patients, while manufacturer assistance provides free branded medication for qualifying individuals. Compare options carefully, prioritize licensed providers, and work with your doctor to ensure safe, effective treatment.
FAQ
Does Medicare cover weight loss injections like Wegovy or Zepbound?
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 GLP-1 injections 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.