Is Ozempic, Wegovy, and other weight loss medications covered by Medicare?

**Medicare Coverage for Weight Loss Treatments and Medication: What You Need to Know**

**Medicare and Weight Loss Treatments and Medication**

Medicare does not typically cover prescription drugs used for weight loss, including drugs like Ozempic that are not FDA-approved for that purpose. This exclusion is due to the Medicare Modernization Act, which specifically prohibits coverage for weight loss drugs, as well as drugs for erectile dysfunction and other conditions. The act was enacted to address the potential dangers associated with certain weight loss drugs, such as Fen-Phen, which were removed from the market due to serious health risks like hypertension and heart valve problems.

However, Medicare does cover weight loss counseling and certain types of bariatric surgery for individuals aged 65 and older with obesity. This means that Medicare recognizes the importance of addressing obesity as a health concern and provides coverage for treatments that can help individuals manage their weight.

**Medicare Coverage for Ozempic and Mounjaro**

Despite Medicare’s general exclusion of weight loss drugs, it does cover Ozempic and Mounjaro as Part D medications when prescribed to treat diabetes, as these drugs are FDA-approved for this purpose. Interestingly, these expensive medications, with an annual cost of approximately $16,000 for Ozempic and over $13,000 for Mounjaro, have also been shown to promote weight loss in some users.

Although these drugs have demonstrated potential for weight loss, many employer health plans and private health insurers do not cover them for weight loss purposes. According to the Wall Street Journal, fewer than a quarter of employer plans cover any drug specifically for weight loss. This means that individuals seeking weight loss treatment with medications like Ozempic may need to explore other options for coverage and cost management.

**The Potential for Medicare Coverage of Weight Loss Drugs**

There are two potential avenues through which Medicare could cover weight loss drugs like Ozempic for their intended purpose. One option is for Congress to amend the Medicare Modernization Act and allow coverage for weight loss medications. Some drug manufacturers are advocating for this change, but it remains uncertain whether Congress will take action.

Another possibility is the implementation of a demonstration project by the Biden administration. This project would examine whether weight loss drugs prescribed under Medicare have additional beneficial effects, such as lowering cholesterol or improving heart health, which could result in long-term cost savings. However, there has been no public or private indication from the administration regarding such a project at this time.

Given the potential costs associated with covering weight loss drugs under Medicare, it is also possible that pharmaceutical companies could lower the prices of these medications to make them more affordable for individuals who do not have coverage through Medicare.

**Conclusion**

In conclusion, Medicare generally does not cover prescription drugs used for weight loss, excluding them based on the Medicare Modernization Act. However, it does provide coverage for weight loss counseling and certain types of bariatric surgery. Despite this general exclusion, Medicare covers drugs like Ozempic and Mounjaro when prescribed for diabetes treatment, as they are FDA-approved for this purpose. The potential for Medicare coverage of weight loss drugs for their intended purpose depends on possible changes in legislation or the implementation of a demonstration project by the Biden administration. In the meantime, individuals seeking weight loss treatment should explore alternative options for coverage and cost management.