Does Medicare cover GLP-1 medications?
Medicare (Part D)covers GLP-1s differently for weight loss and for type 2 diabetes. Here's what to expect on a Medicare plan as of May 2026.
Medicare prior authorization requirements
- →Statute prohibits Part D coverage for weight-loss-only indications
- →CMS reaffirmed this in 2024
Specific requirements vary by your employer's plan. Check your Summary of Benefits or call member services to confirm.
Drugs typically on Medicare's preferred tier
These have the lowest copays. Non-preferred or excluded drugs cost significantly more.
Important note about Medicare
Federal law (Medicare Modernization Act of 2003) excludes drugs for weight loss from Part D coverage. Workaround: get the diabetes-indicated drug (Ozempic or Mounjaro) if you have a covered diagnosis.
Medicare coverage by drug
Drill into specific cost, prior-auth, and workaround details for each GLP-1 on Medicare.
What if Medicare denies your GLP-1?
- Request the denial letter in writing.It must list the specific criteria you didn't meet.
- Ask your prescriber to file a peer-to-peer appeal. Documenting BMI ≥30, comorbidities (sleep apnea, hypertension, prediabetes), and prior weight-loss attempts often reverses denials.
- If still denied, consider self-pay options: LillyDirect for Zepbound (from $299/mo), NovoCare savings card for Wegovy, or telehealth platforms like Hims, Ro, and Found ($199–$499/mo).
- Use our calculator to compare your effective monthly cost across channels.
Need a step-by-step appeal playbook? See the full GLP-1 prior authorization guide →
Cash-pay backup if Medicare denies your GLP-1
Manufacturer direct prices (LillyDirect, NovoCare) are usually cheapest. Updated May 2026.
| Drug | Insurance | Mfr direct | Telehealth (brand) | Telehealth (compd) | Cash retail | Get it |
|---|---|---|---|---|---|---|
| Wegovy 14.9% weight loss | $63 | $349 | $329 | $249 cheapest | $1,349 | Get → |
| Ozempic 11.6% weight loss | $63 | - | $399 | $199 cheapest | $998 | Get → |
| Wegovy (oral 25mg) 13.6% weight loss | $63 | $149 cheapest | $449 | - | $1,349 | Get → |
| Zepbound 22.5% weight loss | $88 | $299 cheapest | $499 | $299 cheapest | $1,059 | Get → |
| Mounjaro 20.9% weight loss | $88 | - | $499 | $299 cheapest | $1,069 | Get → |
| Saxenda 8.4% weight loss | $63 | - | $399 cheapest | - | $1,349 | Get → |
| Foundayo (orforglipron) 14.7% weight loss | $63 | $149 cheapest | - | - | $1,099 | Get → |