Americans have a growing appetite for prescription drugs such as Ozempic, Wegovy, and Mounjaro. Originally developed to treat Type 2 diabetes, they are now exploding in popularity as a weight loss treatment.
Evidence is mounting that these drugs can offer numerous benefits to the tens of millions of Americans suffering from obesity and its associated health impacts. However, at an average annual cost of $10,000 to $15,000, they are prohibitively expensive for many.
Cost and health considerations have led to a push for expanded coverage of weight loss drugs under public and private health insurance plans. While Medicare is forbidden to cover weight loss drugs, it can cover certain medications, including Ozempic and Wegovy, when they’re prescribed to treat conditions other than weight loss.
Ozempic, Wegovy Now Among the Most-Prescribed
Ozempic, Wegovy, Zepbound, Rybelsus, and Mounjaro have become some of the most popular prescription drugs in the U.S.
They’re often lumped together as weight-loss drugs, but these medications are not all chemically the same and don’t work identically on the body.
- Ozempic, Wegovy, and Rybelsus are known as semaglutide drugs. They belong to the class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, or “single-agonist” drugs.
- Zepbound and Mounjaro are known as tirzepatide drugs. They are GLP-1/GIP receptor agonists, or “dual-agonist” drugs.
- Other GLP-1 drugs, including liraglutide (Saxenda, Victoza) and dulaglutide (Trulicity) are now available as well.
In a country where roughly 42 percent of adults are obese — and two-thirds say willpower alone is not enough to lose weight and keep it off — the market for GLP-1 drugs is vast.
Ozempic debuted in 2017 and was the first of these drugs to hit the market. Just six years later, in 2023, approximately 1 in 60 Americans was prescribed a semaglutide medication.
Market analysts predict that sales of these drugs, which have a list price of up to $1,350 per month, could reach $100 billion by 2030. Some even say they could become the most prescribed drugs ever.
How GLP-1 Drugs Work
Dual-agonist and single-agonist drugs stimulate hormones that help control blood sugar levels and reduce appetite, leading to weight loss. Dual-agonist drugs activate more than one hormone pathway, potentially leading to increased weight loss over medications that activate one hormone pathway.
The drugs also have different manufacturers and are prescribed to treat different conditions. The Food and Drug Administration (FDA) has, for example, approved Ozempic for the treatment of diabetes and to lower the risk of cardiovascular problems. However, some doctors prescribe it “off-label” for weight loss.
Wegovy is approved for weight management and to reduce the risk of heart attack and stroke in obese and overweight adults. And Zepbound is approved exclusively for chronic weight management.
Although the names of these drugs may be a mouthful, they help to curb hunger, make people feel full faster and longer, and have been shown in studies to help patients lose weight because they eat less.
Weight loss varies depending on the GLP-1 one uses and the dose. Clinical studies have shown that patients can lose 15 percent to 24 percent of their body weight. On average, GLP-1 drugs, combined with lifestyle changes, lead to weight loss of about 10 to 15 pounds.
In addition to weight loss, these drugs have been shown to protect against cardiovascular disease and other conditions related to excess weight, such as diabetes, high blood pressure, and high cholesterol.
Medicare’s Weight-Loss Drug Policy
Obesity rates among adults 60 and older have risen in the past decade, from 39.7 percent in 2010 to 41.5 percent in 2020. This age cohort has the country’s second-highest overall obesity rate.
A study published in 2024 found that less than 1 percent of Medicare-aged patients who are overweight or obese, but don’t have Type 2 diabetes, are prescribed GLP-1 treatments.
The reason why is that Medicare — the largest health insurer in the United States — does not cover weight-loss drugs.
This policy is not strictly related to cost, though the price tag to Medicare for covering weight-loss drugs could be significant, at an estimated $13.6 billion to $26.8 billion per year. Rather, it stems from a decades-old stance that many say reflects outdated attitudes toward obesity and ignores the evidence supporting GLP-1 drugs.
At the time the policy became effective, cultural stigmas around obesity portrayed the condition as an individual failing. Anti-obesity medications also had a bad rap, largely due to the infamous “fen-phen” drug that was pulled from the market in 1997 after its link to heart damage was discovered. A New England Journal of Medicine editorial from 1998 opined that “the cure for obesity may be worse than the condition.”
Views on obesity have shifted since then, both culturally and clinically. The Department of Health and Human Services and the American Medical Association now recognize obesity as an illness, and human genetic studies have shown certain people are predisposed to obesity.
GLP-1 drugs have only been on the market for a few years, and their long-term effects are still being studied. Yet current evidence suggests that GLP-1 drugs offer clear clinical benefits, with far milder side effects and fewer risks, according to an editorial in the Journal of General Internal Medicine that calls for reforming Medicare’s Part D coverage policy of anti-obesity medications.
Most American adults agree that Medicare should change its policy to allow weight loss medications. Seventy-six percent of respondents to the National Poll on Healthy Aging said they support coverage for weight loss drugs. About three-quarters said they had been overweight at some point, and 59 percent said they’d be interested in taking a drug like Ozempic or Wegovy.
Does Medicare Cover Ozempic?
Medicare does cover Ozempic — just not specifically for weight loss.
Medicare Part D and some Medicare Advantage plans cover Ozempic prescription costs for people with Type 2 diabetes.
Generally, to obtain this coverage, a doctor must deem it medically necessary. A Medicare plan’s formulary indicates whether it covers Ozempic. Check the Medicare Part D or Medicare Advantage formulary or contact the plan directly to inquire about Ozempic coverage.
Does Medicare Cover Wegovy?
Medicare covers Wegovy under its Part D program for patients who meet specific criteria.
As part of a recently announced policy, Medicare Part D plans can cover Wegovy for patients who have cardiovascular disease and are overweight.
Medicare Part D will not cover Wegovy solely for weight loss. But those who qualify for coverage could see their out-of-pocket drug costs decrease substantially. Wegovy costs $1,350 a month, or more than $16,000 per year. Part D coverage of Wegovy is expected to begin some time in 2024.
Does Medicare Cover Other Weight Loss Drugs?
The Centers for Medicare & Medicaid Services (CMS) policy is that the Medicare prescription drug benefit, Medicare Part D, can cover weight-loss drugs if the drug receives FDA approval for a medically accepted indication besides weight.
In the case of Wegovy, coverage is allowed because the FDA approved Wegovy for a new indication (“to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight”).
The upshot is that Medicare coverage of Wegovy opens the door for other, similar GLP-1 drugs to be covered by Part D as they gain new FDA approvals.
So-called “dual eligibles” who qualify for both Medicare and Medicaid may be able to receive GLP-1 drug coverage through Medicaid in states that offer coverage.
Helping You Understand Changing Medicare Policy
Change is on the horizon when it comes to treating obesity and its related health effects. Health care experts, politicians, and ordinary Americans are expressing increasing support for overturning an outdated Medicare policy that prohibits weight-loss drug coverage. And CMS appears to be inching closer to permitting Medicare coverage of weight loss drugs.
If you have questions about weight loss medications and Medicare, consider working with a local elder law attorney. They can walk you through which drugs your plan permits, how to qualify for coverage, how to enroll in a Part D plan, and more. Find a qualified elder law attorney near you today.
