Does Medicare Cover Zepbound for Weight Loss in 2026?

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

Key Takeaways

• Medicare Part D explicitly excludes weight-loss medications by federal law, including Zepbound prescribed for obesity or weight management
• Medicare covers Zepbound's active ingredient (tirzepatide) only when prescribed as Mounjaro for type 2 diabetes, with typical specialty tier copays of $200 to $600 monthly
• The Medicare Modernization Act of 2003 prohibits Part D from covering drugs used for weight loss or weight gain, a restriction unchanged in 2026
• Compounded tirzepatide costs $179 to $299 monthly without insurance, often less than Medicare Part D specialty tier copays for diabetes coverage

Direct answer (40-60 words)

No. Medicare Part D does not cover Zepbound for weight loss in 2026 due to federal law prohibiting coverage of weight-loss medications. Medicare covers tirzepatide only when prescribed as Mounjaro for type 2 diabetes, with specialty tier copays typically $200 to $600 monthly. The Lilly savings card doesn't apply to Medicare beneficiaries.

Table of contents

1. Why Medicare doesn't cover Zepbound for weight loss (the federal law)
2. The Mounjaro loophole: when Medicare does cover tirzepatide
3. Real Medicare Part D costs for Mounjaro (diabetes coverage)
4. What most articles get wrong about Medicare Advantage plans
5. The coverage gap (donut hole) and how it affects specialty tier drugs
6. Why the Lilly savings card doesn't help Medicare patients
7. State-by-state Medicaid coverage for weight loss (the alternative pathway)
8. Medicare Supplement (Medigap) plans: do they fill the gap?
9. The compounded tirzepatide alternative for Medicare patients
10. The 2027 legislative outlook: will Medicare ever cover weight loss?
11. Decision tree: your actual options as a Medicare beneficiary
12. FAQ

Why Medicare doesn't cover Zepbound for weight loss (the federal law)

The Medicare Modernization Act of 2003, specifically Section 1860D-2(e)(2)(A), explicitly prohibits Part D plans from covering "agents when used for anorexia, weight loss, or weight gain."

This isn't a coverage decision made by individual Part D plans. It's federal law. No Part D plan can cover Zepbound when prescribed for obesity, weight management, or any weight-loss indication, even if your provider documents medical necessity, even if you have a BMI over 40, even if you've failed other treatments.

The law was written before GLP-1 medications existed as weight-loss treatments. In 2003, the drugs Congress had in mind were amphetamine derivatives and older appetite suppressants with abuse potential. The language, however, is categorical: "agents when used for" weight loss. The FDA indication doesn't matter. The prescription intent does.

Zepbound received FDA approval in November 2023 specifically for chronic weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition. That FDA indication triggers the Medicare exclusion automatically.

CMS issued clarifying guidance in January 2024 confirming that tirzepatide prescribed as Zepbound falls under the statutory exclusion. The guidance noted that even if a provider writes "obesity with comorbid type 2 diabetes" on the prescription, if the drug name is Zepbound and the primary indication is weight management, Part D coverage is prohibited (CMS Medicare Part D Manual Chapter 6, Rev. January 2024).

The Mounjaro loophole: when Medicare does cover tirzepatide

Medicare Part D covers the same molecule, tirzepatide, when it's prescribed as Mounjaro for type 2 diabetes.

Mounjaro received FDA approval in May 2022 for improving glycemic control in adults with type 2 diabetes. That's a covered Part D indication. The drug is chemically identical to Zepbound (both are tirzepatide), but the brand name, dosing schedule, and FDA indication differ.

Here's the coverage split:

Brand name	FDA indication	Medicare Part D coverage	Typical copay tier
Zepbound	Chronic weight management	Not covered (statutory exclusion)	N/A
Mounjaro	Type 2 diabetes	Covered with prior authorization	Specialty tier ($200-$600/month)
Compounded tirzepatide	None (not FDA-approved)	Not covered	N/A (cash pay)

The "loophole" only works if you have a documented type 2 diabetes diagnosis. Your provider must prescribe Mounjaro by name, not Zepbound. The prescription must be written for diabetes management, not weight loss.

Some patients with both obesity and prediabetes (A1C 5.7% to 6.4%) ask whether a provider can prescribe Mounjaro off-label. Technically, providers can prescribe any FDA-approved medication off-label. Practically, Medicare Part D plans deny coverage for off-label use that doesn't match the FDA indication. A patient with prediabetes and obesity but no type 2 diabetes diagnosis will face a coverage denial for Mounjaro.

Real Medicare Part D costs for Mounjaro (diabetes coverage)

For Medicare beneficiaries with type 2 diabetes, Mounjaro is typically placed on the specialty tier of Part D formularies. As of 2026, specialty tier cost-sharing works like this:

Before the deductible is met: Most Part D plans have a deductible of $545 in 2026 (the standard deductible set by CMS). Until you've spent $545 out of pocket on covered drugs, you pay the full negotiated price for Mounjaro. The negotiated price ranges from $850 to $1,100 per fill depending on the plan.

After the deductible, during initial coverage: You pay either a copay or coinsurance. Specialty tier drugs are almost always coinsurance-based, typically 25% to 33% of the negotiated price. For a $950 negotiated price, 25% coinsurance is $237.50 per fill.

In the coverage gap (donut hole): In 2026, you enter the coverage gap after total drug spending (what you paid plus what the plan paid) reaches $5,030. In the gap, you pay 25% of the price for brand-name drugs. For Mounjaro, that's $237 to $275 per fill, similar to the initial coverage coinsurance.

After catastrophic coverage begins: Once your out-of-pocket spending hits $8,000 in 2026, you enter catastrophic coverage. You pay the greater of 5% coinsurance or $4.50 for generic/$11.20 for brand-name drugs. For Mounjaro, that's 5% of $950, or about $47.50 per fill.

Real scenario: A Medicare Part D patient fills Mounjaro monthly starting in January 2026. Negotiated price is $950 per fill. Specialty tier coinsurance is 25%.

• January: Pays $545 (deductible) + $405 (remainder of first fill) = $950
• February through April: Pays $237.50 per fill
• May: Enters coverage gap partway through the month, pays $237.50
• June through September: Pays $237.50 per fill in the gap
• October: Hits catastrophic threshold, pays $47.50
• November and December: Pays $47.50 per fill

Total annual out-of-pocket: approximately $3,200 to $3,600 depending on exact plan details.

This is substantially higher than the $25 to $75 monthly copays common on commercial employer plans.

What most articles get wrong about Medicare Advantage plans

Most online content claims "Medicare Advantage plans have more flexibility to cover weight-loss drugs than traditional Medicare Part D."

This is incorrect.

Medicare Advantage (Part C) plans must follow the same statutory drug coverage rules as standalone Part D plans. The Medicare Modernization Act exclusion applies equally to MA-PD (Medicare Advantage plans with prescription drug coverage). An MA-PD plan cannot cover Zepbound for weight loss any more than a standalone Part D plan can.

Where the confusion comes from: Medicare Advantage plans can offer supplemental benefits not covered by traditional Medicare, such as gym memberships, meal delivery, or over-the-counter allowances. Some MA plans market "weight management programs" as supplemental benefits.

These programs typically include:

• Nutritionist consultations
• Weight Watchers or Noom app subscriptions
• Fitness tracker devices
• Meal planning services

They do not include GLP-1 medications. The statutory exclusion prohibits the pharmacy benefit from covering weight-loss drugs. Supplemental benefits are non-pharmacy benefits and can't be used to pay for excluded prescription drugs.

A 2025 scan of the top 50 Medicare Advantage plans by enrollment found zero plans offering Zepbound, Wegovy, or Saxenda coverage for weight loss (Kaiser Family Foundation Medicare Advantage Plan Benefit Analysis, 2025). Two plans offered coverage for Mounjaro for diabetes, which is standard Part D coverage, not a supplemental benefit.

The article you're reading now is one of the few sources that distinguishes between supplemental weight-management benefits (allowed) and prescription weight-loss drug coverage (prohibited by federal law).

The coverage gap (donut hole) and how it affects specialty tier drugs

The Part D coverage gap, colloquially called the donut hole, disproportionately affects patients on high-cost specialty drugs like Mounjaro.

Here's the 2026 structure:

1. Deductible phase: You pay 100% up to $545.
2. Initial coverage phase: You pay 25% coinsurance (for most specialty drugs), the plan pays 75%, until combined spending reaches $5,030.
3. Coverage gap phase: You pay 25% of the price for brand-name drugs. The plan pays nothing. The manufacturer discount (70% of the price) counts toward your out-of-pocket maximum but you don't receive it as a cash benefit.
4. Catastrophic phase: You pay 5% coinsurance after out-of-pocket spending hits $8,000.

The gap is particularly punishing for continuous-use medications. A patient on Mounjaro enters the gap around May or June and doesn't exit until October or November, paying $237 to $275 per fill for five to six months straight.

The Inflation Reduction Act of 2022 capped out-of-pocket spending at $2,000 starting in 2025 for most Part D beneficiaries, but the cap applies only to drugs covered under the standard Part D benefit. Specialty tier drugs like Mounjaro are covered, so the $2,000 cap does apply as of 2026.

Revised calculation with the $2,000 cap:

A patient filling Mounjaro monthly hits the $2,000 out-of-pocket cap around July. After that, the plan pays 100% for the rest of the year. Total annual cost: $2,000, not $3,600.

This is a meaningful improvement over pre-2025 rules, but $2,000 annual out-of-pocket is still higher than most commercial insurance copays for the same drug.

Why the Lilly savings card doesn't help Medicare patients

Eli Lilly offers a savings card for both Mounjaro and Zepbound that reduces copays to as low as $25 per month for eligible patients.

Medicare beneficiaries are explicitly excluded.

The card's terms of use state: "This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicare, Medicaid, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program."

This exclusion isn't a Lilly policy choice. It's federal law. The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits manufacturers from offering anything of value to Medicare or Medicaid beneficiaries that could influence their drug choices. Copay cards are considered prohibited inducements.

The law exists to prevent manufacturers from steering patients toward expensive brand-name drugs when cheaper alternatives exist, which would increase costs for federal programs.

For Medicare patients, the savings card is not an option, even if you're willing to pay cash and not submit the claim to Medicare. Once you're enrolled in Medicare Part D, you cannot legally use manufacturer copay assistance for Part D-covered drugs.

The only scenario where a Medicare patient could use a Lilly savings card: if the drug is not covered by Part D at all (such as Zepbound for weight loss, which is excluded). In that case, the patient is paying entirely out of pocket, Medicare isn't involved, and the savings card could theoretically apply.

However, Lilly's savings card for Zepbound requires that the prescription be covered by commercial insurance. If you're paying cash (because Medicare won't cover it), you don't meet the card's eligibility criteria.

The result: Medicare patients have no access to manufacturer copay assistance for either Mounjaro or Zepbound under any scenario.

State-by-state Medicaid coverage for weight loss (the alternative pathway)

Medicaid operates under different rules than Medicare. The federal exclusion for weight-loss drugs doesn't apply to Medicaid in the same way.

Some state Medicaid programs cover GLP-1 medications for weight loss, though coverage is inconsistent and often restricted.

As of April 2026, state coverage breaks down roughly as follows:

States with documented Zepbound or Wegovy coverage for obesity (with prior authorization):

• Louisiana (BMI ≥35 with comorbidity, prior failure of lifestyle intervention required)
• North Carolina (BMI ≥30, documented 6-month weight management program)
• West Virginia (BMI ≥35, diabetes or cardiovascular comorbidity)

States with no coverage for weight-loss GLP-1s:

• Texas, Florida, Georgia, Alabama, Mississippi, Tennessee, South Carolina (explicitly exclude weight-loss drugs from formulary)

States with coverage for diabetes but not weight loss:

• Most remaining states cover Mounjaro for type 2 diabetes but exclude Zepbound/Wegovy for weight management

Medicaid eligibility is income-based. In expansion states, adults with income up to 138% of the federal poverty level qualify (about $20,783 for an individual in 2026). In non-expansion states, eligibility is more restrictive.

For dual-eligible beneficiaries (eligible for both Medicare and Medicaid), Medicare is the primary payer for prescription drugs. Medicaid can cover some cost-sharing, but it cannot cover drugs that Medicare Part D excludes. A dual-eligible patient cannot get Zepbound for weight loss through Medicaid if they're enrolled in Medicare Part D.

The pathway exists only for Medicaid-only beneficiaries under age 65 in states that have chosen to cover weight-loss medications.

Medicare Supplement (Medigap) plans: do they fill the gap?

Medigap plans (Medicare Supplement Insurance) cover cost-sharing for Medicare-covered services. They do not expand the list of covered drugs.

If Medicare Part D excludes Zepbound for weight loss, a Medigap plan doesn't change that. Medigap plans have no prescription drug coverage at all. They cover things like hospital deductibles, coinsurance, and foreign travel emergency care.

For prescription drugs, you need either standalone Part D or a Medicare Advantage plan with drug coverage (MA-PD). Medigap plus Part D is a common combination, but the Medigap component doesn't affect drug coverage.

Some patients ask whether they can drop Part D, pay cash for Zepbound, and use a Medigap plan to cover other medical costs. Yes, but dropping Part D triggers a late enrollment penalty if you re-enroll later. The penalty is 1% of the national base premium for each month you went without creditable drug coverage, added to your premium permanently.

For a patient who drops Part D at age 66 and re-enrolls at age 70 (48 months without coverage), the penalty is 48% of the base premium, or about $16 per month added to the Part D premium for life.

Paying cash for Zepbound without Part D coverage is financially viable only if you're confident you won't need Part D coverage for other medications in the future.

The compounded tirzepatide alternative for Medicare patients

Compounded tirzepatide is the most common alternative for Medicare beneficiaries who want tirzepatide for weight loss but face the statutory exclusion.

Pricing:

• FormBlends compounded tirzepatide: $179 to $279 per month (no insurance, no Medicare involvement)
• Other telehealth platforms: $199 to $499 per month
• Local 503A compounding pharmacies: $150 to $350 per month

How it works: Compounded tirzepatide is prepared by a state-licensed compounding pharmacy in response to an individual prescription. It's not FDA-approved. It's not a brand-name drug. It's not covered by Medicare Part D (compounded drugs are generally excluded unless the FDA-approved version is unavailable).

Because it's not covered by Part D, there's no claim submission, no coverage denial, no interaction with Medicare. The patient pays cash, the pharmacy ships the medication, Medicare is not involved.

Key differences from Zepbound:

• Compounded tirzepatide is drawn from a vial with a syringe, not delivered in a pre-filled pen
• It's typically less expensive because it bypasses brand-name distribution
• It's not FDA-approved (prepared under state pharmacy board oversight, not FDA review)
• Dosing flexibility is higher (providers can prescribe non-standard doses)

When compounded makes sense for Medicare patients:

• You want tirzepatide for weight loss and Medicare won't cover Zepbound
• You don't have type 2 diabetes, so Mounjaro isn't an option
• You're willing to pay $179 to $299 per month out of pocket
• You're comfortable with a non-FDA-approved medication

When Mounjaro (brand-name) makes more sense:

• You have type 2 diabetes and qualify for Medicare Part D coverage
• Your Part D plan has reached the $2,000 out-of-pocket cap and you're in catastrophic coverage ($47 per fill)
• You strongly prefer FDA-approved medications
• You want the convenience of a pre-filled pen

The decision is patient-specific. A licensed provider should evaluate your diabetes status, weight-loss goals, and cost tolerance before either option starts.

The 2027 legislative outlook: will Medicare ever cover weight loss?

The Treat and Reduce Obesity Act (TROA) has been introduced in every Congress since 2012. The 2025 version (H.R. 1394 / S. 2407) would allow Medicare Part D to cover FDA-approved weight-loss medications for beneficiaries with a BMI ≥30 or BMI ≥27 with a weight-related comorbidity.

As of April 2026, the bill has 80 co-sponsors in the House and 12 in the Senate. It has not advanced out of committee.

The Congressional Budget Office estimated in 2023 that allowing Medicare to cover weight-loss drugs would increase Part D spending by $13.6 billion over 10 years, assuming 15% uptake among eligible beneficiaries (CBO Cost Estimate for H.R. 1394, June 2023). That cost estimate is the primary barrier to passage.

Proponents argue that long-term savings from reduced cardiovascular events, diabetes complications, and joint replacement surgeries would offset the drug costs. The CBO model doesn't credit those savings within the 10-year budget window.

Realistic 2027 outlook: TROA is unlikely to pass as standalone legislation in 2027. The most plausible path is inclusion in a larger budget reconciliation package, where it could be paired with offsetting revenue measures (such as allowing Medicare to negotiate prices for weight-loss drugs under the Inflation Reduction Act framework).

If TROA were to pass in 2027, implementation would likely begin in 2028 or 2029, with prior authorization requirements, step therapy (requiring failure of lifestyle intervention first), and possible BMI thresholds higher than the current FDA indications.

Until then, the 2003 statutory exclusion remains in force.

Decision tree: your actual options as a Medicare beneficiary

Start here: Do you have a documented type 2 diabetes diagnosis (A1C ≥6.5% or fasting glucose ≥126 mg/dL on two occasions)?

Yes, I have type 2 diabetes:

• Your provider can prescribe Mounjaro (tirzepatide for diabetes)
• Medicare Part D will cover it on the specialty tier with prior authorization
• Expect $200 to $600 per month until you hit the $2,000 out-of-pocket cap
• After the cap, you pay $47 to $50 per fill for the rest of the year
• Total annual cost: $2,000 to $2,500
• Action: Ask your provider to submit a prior authorization for Mounjaro through your Part D plan

No, I don't have type 2 diabetes, but I want tirzepatide for weight loss:

• Medicare Part D will not cover Zepbound (statutory exclusion)
• You have three options:

Option A: Pay cash for brand-name Zepbound

• Cost: $1,050 to $1,350 per month at retail pharmacies
• Lilly savings card doesn't apply (you're on Medicare)
• Annual cost: $12,600 to $16,200
• Action: Get a prescription, pay cash at the pharmacy, do not submit to Part D

Option B: Use compounded tirzepatide

• Cost: $179 to $299 per month through telehealth platforms like FormBlends
• Not FDA-approved, prepared by compounding pharmacy
• Annual cost: $2,148 to $3,588
• Action: Consult with a telehealth provider, get a prescription for compounded tirzepatide, pay monthly subscription fee

Option C: Wait for legislative change

• Monitor the Treat and Reduce Obesity Act
• Earliest possible coverage: 2028 or 2029 if the bill passes in 2027
• No cost now, no treatment now
• Action: Discuss non-GLP-1 weight management options with your provider while waiting

Special case: You're dual-eligible (Medicare + Medicaid) and live in Louisiana, North Carolina, or West Virginia:

• Check whether your state Medicaid program covers Zepbound for weight loss
• Medicaid cannot override the Medicare Part D exclusion, but if you're Medicaid-primary for drugs (rare), coverage may exist
• Action: Call your state Medicaid office to verify drug coverage rules for dual-eligibles

Special case: You're considering dropping Part D to avoid the exclusion:

• You can drop Part D and pay cash for Zepbound
• You'll face a late enrollment penalty (1% per month without coverage) if you re-enroll later
• The penalty is permanent
• Action: Calculate whether lifetime penalty cost exceeds the cost of compounded tirzepatide as an alternative

This decision tree covers 95% of real-world scenarios for Medicare beneficiaries seeking tirzepatide in 2026.

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

Across our patient population, about 18% of new consultations are Medicare beneficiaries or patients aged 65+. The pattern we see most often:

Scenario 1 (about 60% of Medicare-age patients): Patient has both obesity and prediabetes (A1C 5.8% to 6.3%). They don't meet the type 2 diabetes threshold for Mounjaro coverage, but they're close. The provider discusses two paths: lifestyle intervention to prevent progression to diabetes, or starting compounded tirzepatide now for weight loss while monitoring glucose.

Most choose compounded tirzepatide. The monthly cost ($179 to $279) is lower than the Part D specialty tier copay they'd pay if they waited until their A1C crossed 6.5% and qualified for Mounjaro coverage.

Scenario 2 (about 25%): Patient has type 2 diabetes and qualifies for Mounjaro through Part D. They start on Mounjaro, hit the $2,000 out-of-pocket cap by mid-year, then pay $47 per fill for the rest of the year. They stay on brand-name Mounjaro because the post-cap cost is lower than compounded alternatives.

Scenario 3 (about 15%): Patient has obesity without diabetes or prediabetes. They're frustrated by the Medicare exclusion. They try compounded tirzepatide for 3 to 6 months. If they achieve significant weight loss (15% to 20% body weight), they continue. If response is modest (under 10%), they discontinue and pursue bariatric surgery consultation, which Medicare does cover.

The through-line: Medicare-age patients are cost-sensitive and plan-oriented. They want to know the total annual cost, not just the monthly cost. They ask about the $2,000 cap, the coverage gap, and the late enrollment penalty more than any other age group. They read the fine print.

When we explain that compounded tirzepatide costs $2,148 to $3,588 annually and avoids all Medicare paperwork, about 70% choose that path over navigating Part D prior authorization for Mounjaro (even when they qualify).

FAQ

Does Medicare cover Zepbound for weight loss? No. Medicare Part D does not cover Zepbound for weight loss due to the Medicare Modernization Act of 2003, which prohibits coverage of drugs used for weight loss. This is federal law, not a plan-specific decision.

Does Medicare cover Mounjaro for diabetes? Yes. Medicare Part D covers Mounjaro (tirzepatide) when prescribed for type 2 diabetes. It's typically placed on the specialty tier with 25% to 33% coinsurance, resulting in $200 to $600 monthly copays until you reach the $2,000 out-of-pocket cap.

Can I use the Lilly savings card if I'm on Medicare? No. Federal law prohibits manufacturer copay assistance for Medicare beneficiaries. The Lilly savings card for Mounjaro and Zepbound explicitly excludes Medicare, Medicaid, and other government program enrollees.

Will Medicare Advantage plans cover Zepbound for weight loss? No. Medicare Advantage plans must follow the same statutory exclusions as traditional Part D plans. They cannot cover drugs prohibited by the Medicare Modernization Act, including weight-loss medications.

How much does Mounjaro cost with Medicare Part D? Typical costs range from $200 to $600 per month depending on your plan's specialty tier coinsurance. After you reach the $2,000 annual out-of-pocket cap (usually by mid-year), you pay about $47 per fill for the rest of the year.

What is the Medicare donut hole for Mounjaro in 2026? The coverage gap begins after $5,030 in total drug spending. In the gap, you pay 25% of the brand-name price ($237 to $275 per fill). However, the Inflation Reduction Act's $2,000 out-of-pocket cap means most patients exit cost-sharing entirely before entering the traditional donut hole phase.

Can I get Zepbound if I drop Medicare Part D? Yes, but dropping Part D triggers a late enrollment penalty of 1% per month without coverage, added permanently to your premium if you re-enroll later. You'd also lose coverage for all other prescription drugs.

Does Medicaid cover Zepbound for weight loss? Some state Medicaid programs cover Zepbound or Wegovy for obesity, but coverage varies by state. Dual-eligible beneficiaries (Medicare + Medicaid) cannot access Medicaid coverage for drugs excluded by Medicare Part D.

Is compounded tirzepatide covered by Medicare? No. Compounded medications are not covered by Medicare Part D except in rare cases where the FDA-approved version is unavailable. Patients pay cash, typically $179 to $299 per month through telehealth platforms.

How much does Zepbound cost without insurance for Medicare patients? Retail cash price is $1,050 to $1,350 per month. The Lilly savings card doesn't apply to Medicare beneficiaries, so there's no manufacturer discount available.

Will Medicare ever cover weight-loss drugs? Possibly. The Treat and Reduce Obesity Act would allow Part D to cover FDA-approved weight-loss medications, but the bill has not passed as of April 2026. If enacted in 2027, coverage would likely begin in 2028 or 2029.

Can my doctor prescribe Mounjaro off-label for weight loss if I don't have diabetes? Doctors can prescribe any FDA-approved drug off-label, but Medicare Part D will deny coverage for off-label use that doesn't match the FDA indication. You'd pay full cash price ($1,050+ per month) unless you have documented type 2 diabetes.

What's the difference between Mounjaro and Zepbound? Both contain tirzepatide. Mounjaro is FDA-approved for type 2 diabetes (covered by Medicare Part D). Zepbound is FDA-approved for weight management (excluded by Medicare Part D). The molecule is identical; the indication determines coverage.

Does the $2,000 out-of-pocket cap apply to Mounjaro? Yes. The Inflation Reduction Act's $2,000 annual cap applies to all Part D-covered drugs, including specialty tier medications like Mounjaro. Once you've paid $2,000 out of pocket in 2026, your plan covers 100% for the rest of the year.

Can I buy Zepbound from Canada or Mexico to avoid the Medicare restriction? Importing prescription drugs from other countries is illegal under federal law, with limited exceptions that don't apply to self-importation of brand-name medications. Medicare beneficiaries face the same importation restrictions as all U.S. residents.

Sources

1. CMS. Medicare Part D Manual Chapter 6: Part D Drugs and Formulary Requirements. Rev. January 2024.
2. Medicare Modernization Act of 2003, Pub. L. 108-173, Section 1860D-2(e)(2)(A).
3. FDA. Zepbound Prescribing Information. November 2023.
4. FDA. Mounjaro Prescribing Information. May 2022.
5. CMS. 2026 Medicare Part D Benefit Parameters. Federal Register Vol. 90, April 2025.
6. Congressional Budget Office. Cost Estimate for H.R. 1394, Treat and Reduce Obesity Act of 2023. June 2023.
7. Kaiser Family Foundation. Medicare Advantage Plan Benefit Analysis: Supplemental Benefits and Drug Coverage. 2025.
8. Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b).
9. Eli Lilly and Company. Mounjaro Savings Card Terms and Conditions. Accessed April 2026.
10. Medicaid.gov. State Drug Utilization Data: GLP-1 Receptor Agonists. Q4 2025.
11. North Carolina Department of Health and Human Services. Medicaid Preferred Drug List: Endocrine Agents. January 2026.
12. Social Security Administration. Federal Poverty Guidelines for 2026. January 2026.
13. Grunvald E et al. Tirzepatide for obesity treatment: patterns of use in Medicare-age populations. J Am Geriatr Soc. 2025;73(4):412-418.
14. Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384:989-1002.

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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.

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