Fact-checked by Adam Kennah, M.D. on . See our fact-checking policy.
Medicare Part D historically excluded weight-loss drugs by statute (since the Medicare Modernization Act of 2003). The March 2024 cardiovascular indication for Wegovy and the December 2024 OSA indication for Zepbound created coverage pathways under non-weight indications. April 2026 CMS guidance expanded the Wegovy pathway.
Covered. Ozempic, Mounjaro, and Trulicity are widely covered on Part D formularies for T2D.
Excluded by statute for weight-loss indication. Wegovy and Zepbound are not covered for weight management under Medicare Part D.
Coverage expanded April 2026. CMS guidance allows Part D plans to cover Wegovy for adults with BMI ≥27 + established cardiovascular disease under the March 2024 FDA CV indication. This is the first material Part D coverage expansion for a weight-management GLP-1 since 2003.
Coverage of Zepbound for OSA in beneficiaries with BMI ≥30 + moderate-to-severe OSA is being added across Part D plans through 2026.
Medicare PA criteria for Wegovy under CV indication: BMI ≥27 + documented established CVD (prior MI, ischemic/hemorrhagic stroke, or symptomatic PAD).
If you qualify under the CV or OSA indication, pursue coverage through your plan. If not: cash-pay compounded GLP-1 is available at substantially lower cost than full retail branded.
The most reliable way to verify coverage is to call the member services number on your insurance card and ask: (1) Is [Wegovy/Zepbound/Ozempic/Mounjaro] on my formulary? (2) What tier? (3) What are the prior authorization criteria? (4) What's my expected copay at each tier? Document the date, the rep's name, and any reference number.
If insurance coverage is unworkable, see our price index for current cash-pay compounded options. Our editor's pick, NexLife, runs $145–$215/month flat-rate.