GLP-1 Medication and Medicare

Here is a reoccurring topic we've been discussing with our clients. I'm sure just like us, you’ve been hearing a lot about GLP-1 medications, like Ozempic and Mounjaro. These drugs have been making headlines for their impact on Type 2 Diabetes and weight management. But how does Medicare cover them? Let’s break it down. 

GLP-1s are a class of drugs that help regulate blood sugar and, in some cases, reduce the risk of cardiovascular disease. They are commonly prescribed for people with Type 2 Diabetes. Now, if you’re on Medicare, here’s what you need to know about how these medications are covered.

Medicare does cover GLP-1 medications—but only when they’re prescribed for specific medical conditions. If a doctor prescribes them to treat Type 2 Diabetes or to lower the risk of heart disease, they can be covered under Medicare Part D.

Since these medications are typically self-administered, they fall under Medicare Part D. That means they can be covered by stand-alone Prescription Drug Plans (PDPs) or Medicare Advantage plans with drug coverage, also known as MA-PDs. But keep in mind, coverage depends on your specific plan and its cost-sharing structure.

Medicare is currently prohibited from covering GLP-1 drugs if they’re prescribed solely for weight loss. This restriction goes back to the original Medicare Part D regulations, which exclude certain drug classes from coverage.

That means if your doctor prescribes a GLP-1 drug just for weight loss—without another qualifying condition—Medicare won’t cover it. This is an important distinction, especially as these medications gain popularity for weight management.

If you’re considering a GLP-1 medication and want to know how it fits into your Medicare coverage, be sure to check with your plan provider.