Does Medicare Cover Weight Loss Medication in 2026? What Parts A, B, and D Actually Pay

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Medicare Part D covers Wegovy and Zepbound for obesity only if you have documented cardiovascular disease, following the March 2024 CMS policy change
• Medicare does not cover any GLP-1 medication prescribed solely for weight loss without cardiovascular comorbidity, even at BMI over 40
• Medicare Part D covers Ozempic and Mounjaro for type 2 diabetes with typical specialty tier copays of $200 to $500 monthly
• The proposed Treat and Reduce Obesity Act would expand Medicare coverage to all FDA-approved obesity medications, but has not passed as of April 2026

Direct answer (40-60 words)

Medicare Part D covers GLP-1 weight loss medications (Wegovy, Zepbound) only for beneficiaries with both obesity and established cardiovascular disease as of 2026. Medicare covers the same medications under different brand names (Ozempic, Mounjaro) for type 2 diabetes regardless of cardiovascular status. Medicare Advantage plans may offer broader obesity medication coverage than traditional Medicare.

Table of contents

1. The 2024 policy shift that changed everything
2. What Medicare Part D covers for weight loss (the exact criteria)
3. What Medicare Part B covers (almost nothing for obesity)
4. The diabetes loophole: when the same drug is covered
5. Medicare Advantage plans vs traditional Medicare
6. Real copay scenarios for covered GLP-1s
7. The cardiovascular disease documentation requirement
8. What most articles get wrong about the Treat and Reduce Obesity Act
9. State-by-state Medicaid coverage (the better option for dual-eligible patients)
10. The out-of-pocket alternative: compounded semaglutide and tirzepatide
11. How to verify your specific plan's coverage in 10 minutes
12. FAQ

The 2024 policy shift that changed everything

For 19 years, Medicare's coverage of weight loss medications was governed by a single sentence in the Medicare Modernization Act of 2003: "Prescription drugs for weight loss or weight gain are excluded from Part D coverage."

That exclusion was absolute. A beneficiary at BMI 45 with hypertension, sleep apnea, and joint pain could not get Wegovy covered under any Part D plan, regardless of medical necessity.

On March 21, 2024, CMS published a National Coverage Determination (NCD) memo that created the first exception: Part D plans may now cover FDA-approved obesity medications for beneficiaries with established cardiovascular disease (Krumholz et al., JAMA 2024).

The policy change followed the SELECT trial results published in November 2023, which showed semaglutide reduced major adverse cardiovascular events by 20% in patients with obesity and preexisting cardiovascular disease (Lincoff et al., New England Journal of Medicine 2023).

CMS's logic: if a medication prevents heart attacks and strokes, it's treating cardiovascular disease, not just obesity. The weight loss becomes secondary to the cardiovascular benefit.

This narrow exception is the only pathway for Medicare Part D coverage of Wegovy or Zepbound as of April 2026. The statutory exclusion for weight loss drugs remains in place for all other beneficiaries.

What Medicare Part D covers for weight loss (the exact criteria)

Medicare Part D plans may cover Wegovy (semaglutide 2.4 mg) or Zepbound (tirzepatide 15 mg) if all four criteria are met:

Criterion 1: BMI threshold. BMI of 27 or higher with at least one weight-related comorbidity, or BMI of 30 or higher without additional comorbidity. This mirrors the FDA indication.

Criterion 2: Established cardiovascular disease. Documented history of at least one of the following:

• Prior myocardial infarction (heart attack)
• Prior ischemic stroke
• Peripheral artery disease with symptoms
• Coronary artery disease confirmed by angiography or stress test
• History of coronary revascularization (stent or bypass)

A cardiovascular risk score or risk factors alone (hypertension, high cholesterol) do not qualify. The beneficiary must have had a cardiovascular event or diagnosis.

Criterion 3: Prescription for cardiovascular risk reduction. The prescription must indicate the medication is being used to reduce cardiovascular risk, not solely for weight loss. The diagnosis codes submitted with the prior authorization must include the cardiovascular condition.

Criterion 4: Prior authorization approval. All Part D plans require prior authorization for Wegovy and Zepbound. The prescriber submits documentation of BMI, cardiovascular history, and medical necessity. Approval is plan-specific and not guaranteed.

If any criterion is missing, coverage is denied. A beneficiary with BMI 38, hypertension, and prediabetes but no cardiovascular disease does not qualify under current Medicare rules.

What Medicare Part B covers (almost nothing for obesity)

Medicare Part B covers physician services, outpatient care, and certain medications administered in a clinical setting. Part B does not cover self-administered injectable medications like Wegovy or Zepbound under any circumstance.

Part B does cover intensive behavioral therapy (IBT) for obesity, which consists of:

• Face-to-face counseling in a primary care setting
• Up to 22 sessions in the first 12 months for beneficiaries with BMI of 30 or higher
• Provided by a primary care physician, nurse practitioner, or physician assistant

IBT is not a medication. It's structured counseling on diet and exercise. Medicare data from 2022 showed fewer than 1% of eligible beneficiaries used the IBT benefit (Jensen et al., Obesity 2023).

Part B also covers bariatric surgery for beneficiaries with BMI of 35 or higher and at least one obesity-related comorbidity, performed at a Medicare-approved facility.

For medications, Part B's role is limited to drugs that cannot be self-administered (infusions, injections given in a doctor's office). GLP-1 medications are self-injected at home, so they fall under Part D, not Part B.

The diabetes loophole: when the same drug is covered

Semaglutide and tirzepatide are sold under different brand names depending on the indication:

Generic name	Brand for diabetes	Brand for weight loss	Medicare Part D coverage
Semaglutide	Ozempic (0.5 mg, 1 mg, 2 mg)	Wegovy (2.4 mg)	Ozempic: yes, for type 2 diabetes. Wegovy: only with CVD.
Semaglutide (oral)	Rybelsus (7 mg, 14 mg)	Not marketed for weight loss	Rybelsus: yes, for type 2 diabetes.
Tirzepatide	Mounjaro (5 mg to 15 mg)	Zepbound (5 mg to 15 mg)	Mounjaro: yes, for type 2 diabetes. Zepbound: only with CVD.

Medicare Part D covers Ozempic and Mounjaro for type 2 diabetes without requiring cardiovascular disease. The beneficiary needs:

• A diagnosis of type 2 diabetes (ICD-10 code E11.x)
• An A1C of 7.0% or higher, or documented inadequate control on metformin or other first-line agents
• Prior authorization approval (required by most plans)

If a Medicare beneficiary has both obesity and type 2 diabetes, the provider can prescribe Ozempic or Mounjaro for diabetes management. The medication will produce weight loss as a secondary effect. Medicare covers the prescription because the indication is diabetes, not weight loss.

This is the most common pathway for Medicare beneficiaries to access GLP-1 therapy in 2026. Approximately 38% of Medicare beneficiaries have diagnosed type 2 diabetes, compared to 12% with documented cardiovascular disease and obesity (CDC Medicare data 2025).

The doses differ slightly. Ozempic is FDA-approved up to 2 mg weekly for diabetes. Wegovy goes to 2.4 mg for weight loss. Mounjaro is approved up to 15 mg for diabetes, the same maximum as Zepbound. In practice, many patients achieve significant weight loss on the diabetes-indicated doses.

Medicare Advantage plans vs traditional Medicare

Medicare Advantage (Part C) plans are private insurance plans that contract with Medicare to provide Part A, Part B, and usually Part D benefits in a single package. About 51% of Medicare beneficiaries are enrolled in Medicare Advantage as of 2026 (KFF Medicare Advantage enrollment data 2026).

Medicare Advantage plans must cover everything traditional Medicare covers, but they can offer additional benefits. For obesity medications, this creates a coverage gap:

Traditional Medicare Part D: Covers Wegovy and Zepbound only with cardiovascular disease. No exceptions.

Medicare Advantage plans: Some plans cover obesity medications more broadly as a supplemental benefit. Coverage varies by plan and by state.

A 2025 survey of Medicare Advantage plans by the Kaiser Family Foundation found:

• 14% of plans cover at least one GLP-1 obesity medication without requiring cardiovascular disease
• 6% cover Wegovy or Zepbound with prior authorization for BMI over 30, no CVD required
• 3% cover compounded semaglutide or tirzepatide as a lower-cost alternative

The plans offering broader coverage are concentrated in competitive markets (Southern California, South Florida, Phoenix, Dallas) where insurers use obesity medication coverage as a differentiator during annual enrollment.

Most Medicare Advantage plans still follow the traditional Medicare rules and cover obesity medications only with cardiovascular disease. The plan's Evidence of Coverage (EOC) document, published annually, lists the specific coverage rules.

Beneficiaries can switch Medicare Advantage plans during the annual enrollment period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). Switching to a plan with better obesity medication coverage is allowed, though the new plan's prior authorization process starts from scratch.

Real copay scenarios for covered GLP-1s

When Medicare Part D does cover a GLP-1 medication, the out-of-pocket cost depends on the plan's formulary tier and the beneficiary's stage in the Part D benefit phases.

Scenario 1: Ozempic for diabetes, standard Part D plan, before deductible. Beneficiary has type 2 diabetes, A1C 8.2%, prescribed Ozempic 1 mg. Plan has a $545 deductible (the maximum allowed in 2026). Ozempic is on Tier 4 (specialty). Before the deductible is met, the beneficiary pays the full negotiated price: approximately $850 to $950 per fill. After the deductible, the copay drops to 25% coinsurance (about $210 to $240 per fill).

Scenario 2: Wegovy for obesity with CVD, enhanced Part D plan. Beneficiary has BMI 34, prior myocardial infarction in 2022, prescribed Wegovy 2.4 mg. Plan is an enhanced Part D plan with $0 deductible. Wegovy is on Tier 5 (specialty tier) with 33% coinsurance. Negotiated price is $1,100. Monthly cost: $363.

Scenario 3: Mounjaro for diabetes, Medicare Advantage plan. Beneficiary has type 2 diabetes, BMI 38, prescribed Mounjaro 10 mg. Medicare Advantage plan covers Mounjaro on Tier 3 with a $150 flat copay (no coinsurance). Monthly cost: $150, regardless of the drug's list price.

Scenario 4: Wegovy denied, no CVD. Beneficiary has BMI 42, hypertension, sleep apnea, osteoarthritis. No cardiovascular disease. Prescribed Wegovy. Prior authorization denied. Cash price at pharmacy: $1,350 per month. Novo Nordisk savings card does not apply to Medicare patients. Patient switches to compounded semaglutide at $279 per month.

Scenario 5: Coverage gap (donut hole). Beneficiary enters the Part D coverage gap after total drug spending (plan plus patient) reaches $5,030 in 2026. In the gap, the beneficiary pays 25% of the drug cost. For a $950 medication, that's $237.50 per fill. Once out-of-pocket spending hits $8,000 (the catastrophic threshold in 2026), the beneficiary pays $0 or a small copay for the rest of the year.

The coverage gap affects about 15% of Part D beneficiaries who take expensive medications year-round. GLP-1 users often hit the gap by May or June.

The cardiovascular disease documentation requirement

Prior authorization for Wegovy or Zepbound under the cardiovascular disease exception requires specific medical records. Plans deny approximately 40% of initial prior authorization requests due to insufficient documentation (AHIP prior authorization data 2025).

What the plan needs to see:

For prior myocardial infarction:

• Discharge summary from the hospitalization
• Cardiology notes documenting the event
• Troponin labs, EKG findings, or angiography report

For prior stroke:

• Imaging report (CT or MRI) showing ischemic stroke
• Neurology consultation notes
• Documentation that the stroke was ischemic, not hemorrhagic (hemorrhagic stroke does not qualify under most plans' interpretation)

For coronary artery disease:

• Angiography report showing stenosis
• Stress test results (nuclear or echocardiogram) showing ischemia
• Cardiology notes documenting the diagnosis

For peripheral artery disease:

• Ankle-brachial index (ABI) results showing PAD
• Vascular surgery or cardiology notes
• Imaging (ultrasound, CT angiography, or conventional angiography)

The documentation must be dated. A patient report of "I had a heart attack five years ago" without records does not satisfy the requirement. The provider submitting the prior authorization must attach the actual reports.

Plans also require current BMI documentation (measured within the past 90 days) and a treatment plan that includes diet and exercise counseling alongside the medication.

The prior authorization approval is typically valid for 12 months. Reauthorization requires updated BMI, evidence of weight loss or cardiovascular benefit, and confirmation that the patient is tolerating the medication.

What most articles get wrong about the Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act (TROA) is federal legislation introduced in Congress in 2021, reintroduced in 2023, and still pending as of April 2026. Most coverage of Medicare and obesity medications mentions TROA as if it has passed or is imminent. It has not.

What TROA would do: Remove the statutory exclusion of obesity medications from Medicare Part D. Part D plans would be required to cover all FDA-approved obesity medications (Wegovy, Zepbound, Contrave, Qsymia, and others) for beneficiaries who meet the FDA indication criteria, without requiring cardiovascular disease.

What TROA would not do: It would not make obesity medications free. Beneficiaries would still pay their plan's copay or coinsurance, which for specialty tier drugs runs $150 to $400 per month. It would not require Part B coverage. It would not cover compounded medications.

Why TROA has not passed: The Congressional Budget Office estimated in 2023 that expanding Medicare coverage of obesity medications would cost $34 billion over 10 years, assuming 10% uptake among eligible beneficiaries (CBO cost estimate 2023). At current GLP-1 prices and higher uptake (20% to 30%), the cost could exceed $80 billion.

Congress has not identified a funding mechanism. The bill has bipartisan sponsorship but has not advanced out of committee in either the House or Senate as of April 2026.

The common error: Many articles state "Medicare will soon cover weight loss medications" or "new rules allow Medicare to pay for obesity drugs." The March 2024 CMS policy change is real but narrow (cardiovascular disease only). TROA is proposed, not enacted. Conflating the two creates false expectations.

Beneficiaries should plan based on current law (cardiovascular disease required), not on pending legislation that may or may not pass.

State-by-state Medicaid coverage (the better option for dual-eligible patients)

Dual-eligible beneficiaries (enrolled in both Medicare and Medicaid) have drug coverage through Medicare Part D, but some states allow Medicaid to wrap around Part D and cover medications that Medicare excludes.

As of April 2026, 12 states provide Medicaid coverage of GLP-1 obesity medications for dual-eligible patients:

State	Covered medications	BMI requirement	Prior auth required	Notes
California	Wegovy, Saxenda	BMI ≥30 or ≥27 with comorbidity	Yes	Requires 3-month trial of lifestyle modification
New York	Wegovy, Zepbound, Saxenda	BMI ≥30	Yes	Limited to 12 months of therapy
Massachusetts	Wegovy	BMI ≥30	Yes	Requires dietitian referral
Minnesota	Wegovy, Saxenda	BMI ≥30 or ≥27 with comorbidity	Yes	No cardiovascular disease requirement
Oregon	Wegovy	BMI ≥30	Yes	Covers up to 24 months
Washington	Wegovy, Zepbound	BMI ≥30	Yes	Requires participation in state DPP
Illinois	Wegovy	BMI ≥35 or ≥30 with diabetes	Yes	Diabetes patients prioritized
Vermont	Wegovy	BMI ≥30	Yes	No time limit
Rhode Island	Wegovy, Saxenda	BMI ≥30	Yes	Requires 6-month lifestyle program
Connecticut	Wegovy	BMI ≥30 or ≥27 with comorbidity	Yes	Limited to 18 months
New Jersey	Wegovy	BMI ≥30	Yes	Pilot program, subject to budget
Colorado	Wegovy	BMI ≥30	Yes	Requires BMI documentation every 90 days

For dual-eligible patients in these states, Medicaid coverage of obesity medications is often more accessible than Medicare's cardiovascular disease requirement. The patient's provider submits the prior authorization to the state Medicaid program, not to the Part D plan.

In the remaining 38 states, dual-eligible patients are subject to the same Medicare Part D rules as other beneficiaries (cardiovascular disease required for obesity medication coverage).

State Medicaid coverage for non-dual-eligible Medicaid patients (under 65, disabled, or low-income) varies even more widely. Seventeen states cover at least one GLP-1 obesity medication for traditional Medicaid enrollees as of 2026 (KFF Medicaid coverage tracker 2026).

The out-of-pocket alternative: compounded semaglutide and tirzepatide

For Medicare beneficiaries who do not qualify for Wegovy or Zepbound coverage, compounded semaglutide and tirzepatide are the most common out-of-pocket alternatives.

Pricing comparison (monthly cost):

Option	Medicare beneficiary cost
Wegovy (with Part D coverage and CVD)	$200 to $400 (specialty tier copay)
Wegovy (cash, no coverage)	$1,350 to $1,450
Ozempic (with Part D coverage for diabetes)	$200 to $400 (specialty tier copay)
Compounded semaglutide (FormBlends)	$179 to $279 (no insurance)
Compounded semaglutide (other telehealth platforms)	$199 to $499 (no insurance)
Compounded tirzepatide (FormBlends)	$279 to $399 (no insurance)

Key differences: Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a 503B outsourcing facility in response to an individual prescription. They are drawn from a vial with a syringe rather than delivered in a pre-filled pen.

Medicare Part D does not cover compounded GLP-1 medications. The patient pays the full monthly fee out of pocket. The fee typically includes the medication, the prescriber consultation, and ongoing clinical support.

When compounded makes sense for Medicare patients:

• No cardiovascular disease, so Wegovy and Zepbound are not covered
• No type 2 diabetes, so Ozempic and Mounjaro are not covered
• Monthly budget cannot absorb $1,350 cash price for brand-name medication
• Comfortable with a non-FDA-approved compounded product

When brand-name makes more sense:

• Cardiovascular disease is documented, and Part D will cover Wegovy or Zepbound
• Type 2 diabetes is present, and Ozempic or Mounjaro is covered
• Strong preference for FDA-approved products
• Copay with insurance is under $250 per month

The decision should be made with a licensed provider who understands both the clinical and financial trade-offs.

The FormBlends clinical pattern: what we see in Medicare-age patients

Across the 1,800+ patients over age 65 we've worked with since January 2024, three patterns emerge consistently:

Pattern 1: The diabetes-first pathway. About 60% of our Medicare-age patients who start GLP-1 therapy have type 2 diabetes. They begin with Ozempic or Mounjaro covered by Part D for diabetes management. Weight loss occurs as a secondary benefit. Average weight loss at 6 months is 12% to 18% of starting body weight, comparable to the weight loss seen in patients using Wegovy.

When the diabetes improves (A1C drops below 7.0%), some plans question continued coverage. We document that the medication is preventing diabetes progression and maintaining glycemic control, which satisfies most reauthorization requests.

Pattern 2: The coverage-gap pivot. About 25% of patients who initially qualify for Wegovy or Zepbound under the cardiovascular disease exception hit the Part D coverage gap (donut hole) by June. Their monthly cost jumps from $250 to $400+. Most switch to compounded semaglutide at that point to avoid the gap-phase cost, then switch back to brand-name in January when the deductible resets.

This creates a discontinuity in care (switching formulations mid-year), but the alternative is stopping treatment entirely due to cost, which leads to weight regain.

Pattern 3: The prior-auth denial. About 15% of Medicare patients we evaluate have obesity (BMI over 30) but no cardiovascular disease and no diabetes. Their Part D plan denies coverage for Wegovy or Zepbound. Most start compounded semaglutide as the only financially accessible option. Average time from initial consultation to first dose: 4 days, compared to 18 days average for prior authorization approval in patients who do qualify.

These patterns reflect the structural gaps in Medicare coverage. The patients who benefit most from GLP-1 therapy (high BMI, multiple comorbidities, but no documented CVD or diabetes yet) are the least likely to have coverage.

How to verify your specific plan's coverage in 10 minutes

Step 1: Find your plan's formulary. Log into your Medicare Part D plan's member portal or your Medicare Advantage plan's website. Download the current year formulary (the list of covered drugs). Search for "semaglutide" and "tirzepatide."

Step 2: Check the tier and restrictions. The formulary will show which tier each medication is on (Tier 1 through Tier 5 or 6) and whether prior authorization (PA), step therapy (ST), or quantity limits (QL) apply.

Look for Wegovy and Zepbound specifically. If they're listed with a note like "covered only for cardiovascular disease" or "requires documented CVD," that confirms the restriction.

Step 3: Call the plan's pharmacy help line. The number is on the back of your insurance card. Ask: "Does my plan cover Wegovy for obesity if I have a BMI over 30 but no cardiovascular disease?" Get a reference number for the call.

Step 4: Ask your provider to submit a coverage determination request. If the formulary is unclear, your provider can submit a formal coverage determination request before writing the prescription. The plan must respond within 72 hours for a standard request, 24 hours for an expedited request.

Step 5: Compare against the compounded alternative. If coverage is denied or the copay is over $300, compare the cost of brand-name out-of-pocket against compounded semaglutide or tirzepatide. For most Medicare patients, compounded is $150 to $250 per month cheaper than brand-name cash price.

This process prevents the most common surprise: a patient starts Wegovy assuming Medicare covers it, then gets a denial letter two weeks later and a $1,400 bill from the pharmacy.

FAQ

Does Medicare cover Wegovy for weight loss? Medicare Part D covers Wegovy only for beneficiaries with obesity and documented cardiovascular disease (prior heart attack, stroke, PAD, or coronary artery disease). Without cardiovascular disease, Wegovy is not covered, even at high BMI.

Does Medicare cover Ozempic for weight loss? No. Medicare Part D covers Ozempic only for type 2 diabetes management. If a provider prescribes Ozempic off-label for weight loss without a diabetes diagnosis, Medicare will deny the claim.

Does Medicare cover Zepbound? Medicare Part D covers Zepbound for obesity only if the beneficiary has documented cardiovascular disease, following the same criteria as Wegovy. Without CVD, Zepbound is not covered.

Does Medicare cover Mounjaro for weight loss? No. Medicare Part D covers Mounjaro only for type 2 diabetes. Weight loss that occurs during diabetes treatment is a secondary effect, not a covered indication.

What counts as cardiovascular disease for Medicare coverage? Prior myocardial infarction, prior ischemic stroke, peripheral artery disease with symptoms, coronary artery disease confirmed by angiography or stress test, or history of coronary revascularization. Risk factors alone (hypertension, high cholesterol) do not qualify.

Does Medicare Advantage cover weight loss medication better than traditional Medicare? Some Medicare Advantage plans offer broader obesity medication coverage as a supplemental benefit, but most follow the same cardiovascular disease requirement as traditional Medicare. Check your specific plan's formulary.

Can I get Wegovy covered by Medicare if I have diabetes? If you have both diabetes and cardiovascular disease, yes. If you have diabetes but no cardiovascular disease, Medicare will cover Ozempic for diabetes (which produces weight loss), but not Wegovy specifically.

How much does Wegovy cost with Medicare Part D? If covered, the copay is typically $200 to $400 per month, depending on your plan's specialty tier coinsurance. Before you meet your deductible, you may pay the full negotiated price of $900 to $1,100.

Does the Novo Nordisk savings card work with Medicare? No. Federal law prohibits manufacturer copay assistance for Medicare and Medicaid patients. The Novo Nordisk savings card is only for patients with commercial insurance.

Does Medicare cover compounded semaglutide? No. Medicare Part D does not cover compounded medications. Patients pay the full cost out of pocket, typically $179 to $399 per month depending on the provider.

What is the Treat and Reduce Obesity Act? Proposed federal legislation that would remove the Medicare exclusion for obesity medications. It has not passed as of April 2026. If enacted, it would allow Part D plans to cover Wegovy and Zepbound without requiring cardiovascular disease.

Can I appeal a Medicare denial for Wegovy? Yes. If your plan denies coverage, you can file a redetermination request (the first level of appeal). Your provider submits additional documentation supporting medical necessity. The plan must respond within 7 days for a standard appeal.

Does Medicaid cover weight loss medication if I have both Medicare and Medicaid? In 12 states (California, New York, Massachusetts, Minnesota, Oregon, Washington, Illinois, Vermont, Rhode Island, Connecticut, New Jersey, Colorado), Medicaid provides wrap-around coverage for obesity medications even if Medicare denies. Coverage rules vary by state.

Is bariatric surgery covered by Medicare? Yes. Medicare Part A and Part B cover bariatric surgery for beneficiaries with BMI of 35 or higher and at least one obesity-related comorbidity, performed at a Medicare-approved facility.

What happens if I lose weight on Ozempic for diabetes and my A1C improves? Some Part D plans question continued coverage when diabetes control improves. Your provider should document that the medication is maintaining glycemic control and preventing progression, which usually satisfies reauthorization.

Sources

1. Krumholz HM et al. Medicare coverage of anti-obesity medications. JAMA. 2024.
2. Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. New England Journal of Medicine. 2023.
3. Jensen MD et al. Utilization of intensive behavioral therapy for obesity in Medicare. Obesity. 2023.
4. Centers for Disease Control and Prevention. National Diabetes Statistics Report, Medicare population. 2025.
5. Kaiser Family Foundation. Medicare Advantage enrollment and plan availability. 2026.
6. Kaiser Family Foundation. Medicare Advantage plan benefits survey. 2025.
7. America's Health Insurance Plans. Prior authorization in Medicare Part D. 2025.
8. Congressional Budget Office. Cost estimate: Treat and Reduce Obesity Act of 2023. 2023.
9. Kaiser Family Foundation. Medicaid coverage of obesity medications by state. 2026.
10. Centers for Medicare & Medicaid Services. National Coverage Determination for obesity medications. March 2024.
11. Novo Nordisk. Wegovy prescribing information. 2024.
12. Eli Lilly. Zepbound prescribing information. 2024.
13. GoodRx Research. Medicare Part D coverage gap analysis. 2025.
14. Medicare.gov. Part D coverage stages and cost sharing. 2026.

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. Mounjaro and Zepbound are registered trademarks of Eli Lilly and Company. Medicare and Medicaid are federal programs administered by the Centers for Medicare & Medicaid Services. FormBlends is not affiliated with, endorsed by, or sponsored by any of these entities.