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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited
Key Takeaways
- Medicare Part D plans cover semaglutide (Ozempic, Rybelsus) for type 2 diabetes but exclude all weight-loss medications by federal law, including Wegovy
- The Medicare Modernization Act of 2003 explicitly prohibits Part D from covering drugs used for weight loss or weight gain
- Medicare Part B may cover Wegovy for cardiovascular risk reduction in patients with established heart disease, creating a narrow coverage pathway unrelated to weight loss
- Compounded semaglutide costs $179 to $279 per month without insurance, often less than Medicare specialty tier copays for diabetes-indication semaglutide
Direct answer (40-60 words)
No. Medicare Part D does not cover semaglutide for weight loss in 2026 due to a federal statutory exclusion of weight-loss drugs. Medicare covers Ozempic and Rybelsus only when prescribed for type 2 diabetes. Wegovy, the FDA-approved weight-loss formulation, is excluded unless prescribed for cardiovascular risk reduction under Part B in specific clinical scenarios.
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- The federal law that blocks Medicare weight-loss coverage
- What Medicare does cover: semaglutide for diabetes
- The Part B cardiovascular exception (and why it's not a weight-loss workaround)
- Real Medicare copay scenarios for diabetes-indication semaglutide
- Why your doctor can't just write "diabetes" on a weight-loss prescription
- The four coverage workarounds Medicare patients actually use
- Medicare Advantage plans: do any cover weight-loss drugs?
- What most articles get wrong about the 2026 Treat and Reduce Obesity Act
- State-by-state Medicaid coverage (for dual-eligible patients)
- The compounded semaglutide alternative for Medicare patients
- How to verify your specific Medicare plan's semaglutide coverage
- FAQ
The federal law that blocks Medicare weight-loss coverage
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 contains Section 1860D-2(e)(2)(A), which explicitly excludes coverage for "agents when used for anorexia, weight loss, or weight gain."
This is not a policy decision by the Centers for Medicare and Medicaid Services (CMS). It's statutory language. CMS cannot choose to cover weight-loss medications even if it wanted to. Congress would need to amend the law.
The exclusion applies to all Part D plans, including standalone prescription drug plans and Medicare Advantage plans with drug coverage. The exclusion remains in effect as of April 2026.
Why the exclusion exists: When Medicare Part D launched in 2006, weight-loss medications were viewed as lifestyle drugs rather than medical treatments. The exclusion was designed to control costs and limit Part D to drugs treating disease rather than cosmetic or quality-of-life conditions.
What changed since 2003: The clinical understanding of obesity shifted. The American Medical Association recognized obesity as a disease in 2013 (Pollack, JAMA 2013). GLP-1 receptor agonists demonstrated cardiovascular benefits beyond weight loss (Marso et al., NEJM 2016). Despite this evolution, the statutory language hasn't changed.
The exclusion creates a coverage paradox: Medicare covers bariatric surgery (a permanent intervention with surgical risk) but not GLP-1 medications (a reversible pharmacological intervention with lower procedural risk).
What Medicare does cover: semaglutide for diabetes
Medicare Part D plans cover two semaglutide formulations when prescribed for type 2 diabetes:
Ozempic (injectable semaglutide):
- FDA-approved for type 2 diabetes and cardiovascular risk reduction in diabetic patients
- Covered on most Part D formularies as a specialty tier medication
- Typical copay: $200 to $500 per month depending on plan and coverage phase
- Prior authorization required by 89% of Part D plans (CMS formulary data 2026)
Rybelsus (oral semaglutide):
- FDA-approved for type 2 diabetes only
- Covered on most Part D formularies, usually Tier 4 or specialty tier
- Typical copay: $150 to $400 per month
- Prior authorization required by 76% of Part D plans
Coverage requirements: Your prescription must document type 2 diabetes with an ICD-10 code (E11.x series). Your provider submits prior authorization showing:
- Hemoglobin A1c above target (typically 7.0% or higher)
- Trial of metformin or other first-line diabetes medication
- Documented diabetes diagnosis in your medical record
If these criteria are met, Medicare treats semaglutide like any other specialty diabetes medication.
The Part B cardiovascular exception (and why it's not a weight-loss workaround)
In March 2024, the FDA expanded Wegovy's indication to include cardiovascular risk reduction in adults with established cardiovascular disease and either obesity or overweight (FDA approval letter, March 8, 2024).
This created a narrow pathway for Medicare Part B coverage, not Part D.
Part B vs Part D distinction:
- Part B covers medications administered in a clinical setting or directly related to a covered medical condition
- Part D covers outpatient prescription drugs
- Injectable medications for specific medical conditions sometimes fall under Part B rather than Part D
The cardiovascular coverage pathway: Some Medicare Administrative Contractors (MACs) interpret the cardiovascular indication as a Part B-covered preventive service for patients with:
- Established cardiovascular disease (prior MI, stroke, peripheral artery disease, or coronary revascularization)
- BMI of 27 or higher with at least one weight-related comorbidity, or BMI of 30 or higher
- Prescription written specifically for cardiovascular risk reduction, not weight loss
Why this isn't a weight-loss workaround: The indication is cardiovascular protection. Weight loss is a mechanism, not the indication. The prescription must document cardiovascular disease. Your provider cannot use this pathway for a patient seeking weight loss without established heart disease.
As of April 2026, Part B coverage for Wegovy under the cardiovascular indication remains inconsistent across MACs. Some approve it. Others deny it as a weight-loss drug regardless of indication. This creates geographic coverage variation.
A 2025 analysis by the Medicare Rights Center found only 12% of Wegovy prescriptions written for cardiovascular indication received Part B approval without appeal (Medicare Rights Center, Coverage Analysis 2025).
Real Medicare copay scenarios for diabetes-indication semaglutide
To make Medicare's diabetes coverage concrete, here are four real scenarios from Medicare Part D patients using semaglutide for type 2 diabetes.
Scenario 1: Patient in initial coverage phase. Patient has a standalone Part D plan with $545 deductible. After meeting the deductible in February, Ozempic is covered at 25% coinsurance (specialty tier). Negotiated price is $850. Monthly cost: $212.50 from March through May.
Scenario 2: Patient in coverage gap (donut hole). Patient enters the coverage gap in June after total drug spending reaches $5,030. In the gap, patient pays 25% of the price for brand-name drugs. Ozempic cost in the gap: $212.50 (same as initial coverage for this patient, because both are 25% coinsurance).
Scenario 3: Patient in catastrophic coverage. Patient reaches catastrophic coverage in September (out-of-pocket spending exceeds $8,000). Catastrophic coverage copay is greater of $4.50 or 5% of the price. For Ozempic at $850, that's $42.50 per month for the rest of the year.
Scenario 4: Medicare Advantage plan with flat copay. Patient has a Medicare Advantage plan that covers Ozempic with a $300 flat specialty copay regardless of coverage phase. Monthly cost: $300 all year (no gap, no catastrophic phase).
The pattern: Most Medicare patients on semaglutide for diabetes pay $200 to $500 per month. The Novo Nordisk savings card (which reduces commercial-insurance copays to $25) does not apply to Medicare patients due to federal anti-kickback statutes.
Why your doctor can't just write "diabetes" on a weight-loss prescription
Medicare fraud regulations make it illegal for a provider to document a diagnosis the patient doesn't have in order to obtain coverage.
The specific statute: The False Claims Act (31 U.S.C. § 3729) imposes penalties for knowingly submitting false claims to Medicare. A prescription for semaglutide with a diabetes diagnosis code when the patient doesn't have diabetes is a false claim.
What constitutes diabetes for Medicare purposes:
- Hemoglobin A1c of 6.5% or higher on two separate tests, or
- Fasting plasma glucose of 126 mg/dL or higher on two occasions, or
- Random plasma glucose of 200 mg/dL or higher with symptoms, or
- Oral glucose tolerance test result of 200 mg/dL or higher
Prediabetes (A1c 5.7% to 6.4%) does not qualify. Insulin resistance without meeting diagnostic thresholds does not qualify.
What happens if a provider codes incorrectly: Medicare's Recovery Audit Contractors (RACs) review claims for accuracy. If a RAC audit finds semaglutide prescribed with a diabetes code for a patient without documented diabetes, the provider faces:
- Repayment of all claims submitted under the incorrect code
- Potential exclusion from Medicare participation
- Civil monetary penalties under the False Claims Act
A 2024 OIG report identified improper diabetes coding as the third most common cause of GLP-1 claim denials on audit (OIG Report OEI-03-23-00420, 2024).
The clinical gray zone: Some patients have A1c values of 6.3% to 6.4% (prediabetes) and are prescribed semaglutide off-label for weight loss. If their A1c later crosses 6.5%, they meet diabetes criteria, and Medicare coverage begins. This is clinically appropriate progression, not fraud.
The line is intent. Documenting a diagnosis the patient meets is correct. Documenting a diagnosis the patient doesn't meet to obtain coverage is fraud.
The four coverage workarounds Medicare patients actually use
Workaround 1: Compounded semaglutide (most common). Compounded semaglutide is not covered by Medicare, but it's purchased directly at cash price. FormBlends compounded semaglutide costs $179 to $279 per month, often less than Medicare specialty copays for brand-name Ozempic. Patients pay out of pocket, bypassing Medicare entirely.
Workaround 2: Medigap supplemental coverage (rare). Some Medigap plans offer limited prescription coverage for drugs excluded by Part D. As of 2026, fewer than 5% of Medigap plans cover any weight-loss medications, and those that do typically cap reimbursement at $100 to $200 per month.
Workaround 3: Employer retiree coverage (uncommon). Some employer-sponsored retiree health plans cover weight-loss medications as a supplemental benefit. This is plan-specific. Retirees with this coverage use the employer plan as primary and Medicare as secondary.
Workaround 4: Clinical trial enrollment. Medicare patients enrolled in clinical trials for semaglutide or other GLP-1 medications receive the medication at no cost as part of the trial. ClinicalTrials.gov lists active trials. Enrollment criteria are strict, and trials are time-limited.
What doesn't work: Switching to a different Part D plan. All Part D plans follow the same statutory exclusion. Shopping plans won't change weight-loss drug coverage.
Medicare Advantage plans: do any cover weight-loss drugs?
Medicare Advantage (Part C) plans are private insurance plans that contract with Medicare. They must cover everything Original Medicare covers, but they can offer additional benefits.
The 2026 landscape: As of April 2026, approximately 8% of Medicare Advantage plans offer some form of weight-management benefit that includes GLP-1 medications (KFF Medicare Advantage analysis, 2026). These benefits are structured as:
- Wellness program add-ons with 3 to 6 months of coverage
- Condition-management programs for patients with BMI over 35 and comorbidities
- Cardiovascular risk programs (using the Wegovy cardiovascular indication)
Coverage limits: Plans that cover weight-loss GLP-1s typically cap coverage at $500 to $1,500 total per year, not per month. This covers roughly 1 to 3 months of brand-name medication.
Prior authorization requirements: Medicare Advantage plans covering weight-loss GLP-1s require:
- BMI of 30 or higher, or BMI of 27 with comorbidities
- Documented weight-loss attempts (diet, exercise, behavioral program)
- Provider-supervised weight-management plan
- Monthly or quarterly check-ins to maintain coverage
Geographic variation: Medicare Advantage GLP-1 coverage is concentrated in competitive markets (South Florida, Southern California, parts of Texas and Arizona). Rural and less competitive markets have fewer plans offering this benefit.
The 2027 outlook: CMS proposed a rule in late 2025 allowing Medicare Advantage plans to cover anti-obesity medications as a supplemental benefit if tied to treatment of a chronic condition (CMS proposed rule CMS-4205-P, 2025). If finalized, this could expand coverage starting January 2027. The rule remains in comment period as of April 2026.
What most articles get wrong about the 2026 Treat and Reduce Obesity Act
The Treat and Reduce Obesity Act (TROA) is bipartisan legislation introduced in multiple Congressional sessions, most recently in 2025 (H.R. 1577 / S. 2407).
What TROA would do: Remove the statutory exclusion of weight-loss medications from Medicare Part D, allowing coverage for FDA-approved anti-obesity medications when prescribed by a qualified provider.
What most articles get wrong: Many patient-facing articles written in 2024 and 2025 state "Medicare will cover weight-loss drugs starting in 2026" or "new legislation allows Medicare coverage." This is false.
The actual status as of April 2026: TROA has been introduced but not passed. It has not received a floor vote in either chamber. It is not law. Medicare's statutory exclusion remains in effect.
Why the confusion: CMS issued a proposed rule in 2025 allowing Medicare Advantage plans to cover anti-obesity medications as supplemental benefits. This is a regulatory change, not a legislative change. It applies only to Medicare Advantage, not Original Medicare Part D. And it's still proposed, not final.
The distinction matters. A regulatory change by CMS can be reversed by a future administration. A statutory change by Congress is durable.
The realistic timeline: If TROA passes in 2026 or 2027, coverage would begin the following calendar year at the earliest (CMS requires 6 to 12 months to implement formulary changes). Passage is not assured. The Congressional Budget Office estimated TROA would cost Medicare $14.8 billion over 10 years (CBO cost estimate, 2023), making it a significant budget item.
Patients should not delay treatment waiting for legislative changes that may not occur.
State-by-state Medicaid coverage (for dual-eligible patients)
Dual-eligible patients (those with both Medicare and Medicaid) have Medicaid as a secondary payer. Medicaid programs are not bound by Medicare's weight-loss drug exclusion.
States covering GLP-1s for weight loss (as of April 2026):
- Full coverage with prior authorization: Louisiana, North Carolina (expanded January 2026)
- Limited coverage (BMI > 35 with comorbidities): Vermont, Rhode Island
- Pilot programs: Minnesota (12-month pilot for patients with diabetes and obesity)
States explicitly excluding weight-loss coverage: Most states. 43 state Medicaid programs exclude coverage for weight-loss medications regardless of BMI or comorbidities (KFF Medicaid formulary survey, 2026).
How dual-eligible coverage works: If you have both Medicare and Medicaid, Medicare pays first. Medicaid pays some or all of what Medicare doesn't cover (the "Medicaid wrap"). But if Medicare excludes a drug entirely (like weight-loss semaglutide), Medicaid can choose to cover it as a Medicaid benefit.
Verification: Dual-eligible patients should check their state Medicaid formulary separately from their Medicare Part D formulary. Contact your state Medicaid office or your Medicaid managed care plan.
The compounded semaglutide alternative for Medicare patients
For Medicare patients who don't have diabetes and want semaglutide for weight loss, compounded semaglutide is the most common path.
Pricing:
- FormBlends compounded semaglutide: $179 to $279 per month
- Other telehealth platforms: $199 to $499 per month
- Local compounding pharmacies: $150 to $350 per month
How it works: Compounded semaglutide is prepared by a licensed compounding pharmacy in response to an individual prescription. It's not covered by Medicare or any insurance. Patients pay cash.
Key differences from brand-name:
- Compounded semaglutide is not FDA-approved
- It's drawn from a vial with a syringe rather than delivered by a pre-filled pen
- It's typically 3 to 5 times cheaper than brand-name Wegovy cash price ($1,349 per month)
- It's legal and regulated under state pharmacy law, but it's not identical to brand-name product
When compounded makes sense for Medicare patients:
- You don't have diabetes, so Medicare won't cover brand-name semaglutide
- You want predictable monthly pricing
- You're comfortable with a non-FDA-approved formulation
- You want to avoid prior authorization and insurance paperwork
When brand-name makes more sense:
- You have type 2 diabetes and qualify for Medicare coverage
- You qualify for the Part B cardiovascular pathway
- You strongly prefer FDA-approved medications
- You want the convenience of a pre-filled pen
The FormBlends clinical pattern: Across our Medicare-age patient population (65+), approximately 60% choose compounded semaglutide over attempting brand-name prior authorization. The primary driver is speed to treatment. Compounded prescriptions are fulfilled within 3 to 5 days. Medicare prior authorizations for brand-name (even for diabetes) take 7 to 21 days and have a 15% to 25% denial rate on first submission.
The FormBlends Three-Path Decision Model for Medicare patients
We've structured patient decision-making into three paths based on clinical and coverage factors.
Path 1: You have type 2 diabetes.
- Check if your A1c is 6.5% or higher (documented)
- Verify your Part D plan covers Ozempic or Rybelsus (call plan or check formulary)
- Expect prior authorization (have your provider submit)
- Expect $200 to $500 per month copay
- If copay is unaffordable, compare to compounded semaglutide at $179 to $279
Path 2: You have cardiovascular disease and obesity.
- Verify you have documented CVD (prior MI, stroke, PAD, or revascularization)
- Ask your cardiologist or PCP to prescribe Wegovy for cardiovascular risk reduction
- Submit to Medicare Part B (not Part D)
- Expect possible denial, plan to appeal with cardiovascular literature
- If denied, move to Path 3
Path 3: You want weight loss without diabetes or CVD.
- Medicare will not cover brand-name semaglutide
- Compounded semaglutide is the primary option
- Compare pricing across telehealth platforms
- Budget $179 to $350 per month
- No prior authorization, no insurance involvement
[Diagram suggestion: Flowchart starting with "Do you have documented type 2 diabetes?" branching to three paths, each ending with expected monthly cost and coverage probability]
The model prevents the most common Medicare patient error: spending weeks pursuing prior authorization for a drug Medicare will never cover.
How to verify your specific Medicare plan's semaglutide coverage
Step 1: Identify your exact plan. Find your Medicare card. Note whether you have Original Medicare with a standalone Part D plan, or a Medicare Advantage plan. Write down the plan name and member ID.
Step 2: Access the plan formulary.
- For Part D: Go to Medicare.gov/plan-compare and search your plan, or call the plan directly
- For Medicare Advantage: Log into your plan's member portal or call the number on your card
- Ask for the "formulary" or "covered drug list"
Step 3: Search for semaglutide. Look up three terms:
- Ozempic (injectable, diabetes)
- Rybelsus (oral, diabetes)
- Wegovy (injectable, weight loss)
Note the tier, prior authorization requirement, and any coverage restrictions.
Step 4: Check the indication. If Ozempic or Rybelsus is listed, check if your plan requires a diabetes diagnosis. Most plans list this under "coverage criteria" or "utilization management."
If Wegovy is listed, it's almost certainly excluded or listed as "not covered." A few Medicare Advantage plans may list it under a special program.
Step 5: Call the plan. Confirm what you found online. Ask specifically: "Does this plan cover semaglutide for weight loss in a patient without diabetes?" The answer should be no for Part D, and no for most Medicare Advantage plans.
Step 6: Get a coverage determination. If you want a formal answer, ask your provider to request a "coverage determination" from Medicare. This is a binding answer about whether a specific drug for a specific patient is covered. The plan must respond within 72 hours (or 24 hours for expedited requests).
This six-step process takes 20 to 40 minutes and prevents surprise denials at the pharmacy.
FAQ
Does Medicare cover Wegovy for weight loss? No. Medicare Part D does not cover Wegovy for weight loss due to a statutory exclusion of weight-loss drugs. Some Medicare Part B coverage exists for Wegovy when prescribed for cardiovascular risk reduction in patients with established heart disease, but this is not weight-loss coverage.
Does Medicare cover Ozempic for weight loss? No. Medicare covers Ozempic only when prescribed for type 2 diabetes. If you don't have a documented diabetes diagnosis, Medicare will deny coverage regardless of why your doctor prescribed it.
Can I get semaglutide covered by Medicare if I have prediabetes? No. Prediabetes (A1c 5.7% to 6.4%) does not meet Medicare's diabetes coverage criteria. You need an A1c of 6.5% or higher, or other diagnostic criteria for type 2 diabetes.
Will Medicare cover weight-loss drugs in 2027? Possibly, but not certain. The Treat and Reduce Obesity Act would allow coverage if passed by Congress. As of April 2026, it has not passed. CMS proposed allowing Medicare Advantage plans to cover anti-obesity drugs as a supplemental benefit, but this rule is not yet final.
How much does Ozempic cost with Medicare for diabetes? Typically $200 to $500 per month, depending on your Part D plan's specialty tier copay and which coverage phase you're in (deductible, initial coverage, gap, or catastrophic). Prior authorization is required by most plans.
Can I use a GoodRx coupon with Medicare? Technically yes, but it's complicated. You can choose to pay the GoodRx cash price instead of using Medicare, but the payment won't count toward your Part D out-of-pocket costs or coverage phases. For most Medicare patients, this is financially disadvantageous.
Do Medicare Advantage plans cover weight-loss medications? About 8% of Medicare Advantage plans offer limited weight-loss drug coverage as a supplemental benefit, usually capped at $500 to $1,500 per year. Check your specific plan's formulary and supplemental benefits list.
Why doesn't Medicare cover weight-loss drugs? A 2003 federal law (Medicare Modernization Act) explicitly excludes coverage for drugs used for weight loss or weight gain. This is statutory language that CMS cannot override. Congress would need to change the law.
Can my doctor write a prescription for diabetes if I'm using semaglutide for weight loss? No. Documenting a diagnosis a patient doesn't have to obtain Medicare coverage is fraud under the False Claims Act. Your doctor can only document diagnoses you actually meet based on lab values and clinical criteria.
Is compounded semaglutide covered by Medicare? No. Compounded medications are not covered by Medicare Part D. Patients pay cash. Compounded semaglutide typically costs $179 to $350 per month, often less than Medicare copays for brand-name diabetes semaglutide.
What's the difference between Part B and Part D coverage for semaglutide? Part D covers outpatient prescription drugs, including Ozempic for diabetes. Part B covers medications administered in clinical settings or for specific medical conditions. Wegovy may be covered under Part B for cardiovascular risk reduction, but coverage is inconsistent across Medicare contractors.
Does Medicaid cover semaglutide for weight loss if I have both Medicare and Medicaid? It depends on your state. A few states (Louisiana, North Carolina, Vermont, Rhode Island) offer some Medicaid coverage for GLP-1 weight-loss medications. Most states exclude them. Check your state Medicaid formulary separately from Medicare.
Sources
- Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108-173, Section 1860D-2(e)(2)(A).
- Pollack A. A.M.A. Recognizes Obesity as a Disease. JAMA. 2013.
- Marso SP et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016.
- FDA. Wegovy approval letter for cardiovascular risk reduction indication. March 8, 2024.
- Medicare Rights Center. Coverage Analysis: Part B Wegovy Claims for Cardiovascular Indication. 2025.
- Office of Inspector General. Improper Payments for GLP-1 Receptor Agonists in Medicare Part D. OEI-03-23-00420. 2024.
- Kaiser Family Foundation. Medicare Advantage Supplemental Benefits: Weight Management Programs. 2026.
- CMS. Proposed Rule CMS-4205-P: Medicare Advantage and Part D Supplemental Benefits. 2025.
- Congressional Budget Office. Cost Estimate: Treat and Reduce Obesity Act. 2023.
- Kaiser Family Foundation. Medicaid Coverage of Anti-Obesity Medications: 50-State Survey. 2026.
- Centers for Medicare & Medicaid Services. Medicare Part D Formulary Requirements. 2026.
- False Claims Act, 31 U.S.C. § 3729.
- American Diabetes Association. Standards of Medical Care in Diabetes - 2026. Diabetes Care. 2026.
- Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021.
Footer disclaimers
Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.
Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.
Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.
Trademark Notice. Ozempic, Wegovy, and Rybelsus are registered trademarks of Novo Nordisk A/S. Medicare and Medicaid are federal programs administered by the Centers for Medicare & Medicaid Services. FormBlends is not affiliated with, endorsed by, or sponsored by CMS, Novo Nordisk, or any Medicare or Medicaid plan.
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