What weight loss drugs does Medicare cover?

Asked by: Prof. Mandy Reichert  |  Last update: November 2, 2023
Score: 4.6/5 (30 votes)

Medicare isn't allowed to cover drugs taken for weight loss because the 20-year-old Medicare Modernization Act specifically excludes them (as well as drugs for erectile dysfunction and a few other types).

Will Medicare pay for Ozempic for weight loss?

But Medicare doesn't cover Ozempic for weight loss — only for diabetes. Nor does Medicare cover Wegovy, a weight loss drug that uses the same active ingredient as Ozempic. In fact, Medicare doesn't cover any prescription drugs for weight loss.

Is there a weight loss drug covered by Medicare?

Medicare coverage of obesity services and treatments currently includes obesity screening, behavioral counseling, and bariatric surgery, but not drugs that are prescribed for weight loss.

How to get Mounjaro for weight loss?

To get Mounjaro for weight loss, a person should speak with a doctor in person or online via a telehealth company. The doctor will decide whether Mounjaro is appropriate for the person's health goals.

What is the monthly cost of Wegovy?

Common questions about Wegovy pricing

GoodRx offers free coupons for Wegovy which can lower the price to as little as $1,308.25 per month; a savings of 23% off the retail price.

Weight loss drugs like Wegovy access limited by insurance and Medicare coverage

36 related questions found

How much weight can you lose in a month with Wegovy?

In clinical trials, Wegovy was shown to reduce body weight in people with body mass indexes, or BMIs, of 27 or greater by around 15% over 68 weeks. People on average lost about an eighth of that weight in the first month.

How quickly do you lose weight on Mounjaro?

Mounjaro Weight Loss Results (Before and After)

Clinical trials studying Mounjaro (tirzepatide) for weight loss found the following results: Participants lost an average of 12-22% of their body weight over about 68 weeks when using the highest doses of Mounjaro (10-15 mg) along with diet and exercise.

Can I lose 50 lbs on Mounjaro?

Mounjaro Weight Loss Results

Clinical trials have shown that people using Mounjaro for weight loss experienced the following results: Average weight loss of 12-15% (around 15-20 lbs) compared to placebo groups that lost only 2-3% of their weight. Some patients lost up to 20-25% (30 lbs or more).

How many pounds do you lose on Mounjaro?

Trial participants given a lower 10 mg dose of Mounjaro, also known as tirzepatide, achieved average weight loss of over 13%, or about 30 pounds (14kg), and nearly 82% lost at least 5% of their body weight.

Will Medicare pay for Mounjaro for weight loss?

These medications, including Novo Nordisk's Ozempic and Wegovy (semaglutide) and Eli Lilly's Mounjaro (tirzepatide), are not covered by Medicare when used for weight loss. The 2003 law that established the Medicare Part D prescription drug benefits prohibits Part D plans from covering drugs used for weight loss.

What are the 6 medications approved for weight loss?

Six weight-loss drugs have been approved by the U.S. Food and Drug Administration (FDA) for long-term use:
  • Bupropion-naltrexone (Contrave)
  • Liraglutide (Saxenda)
  • Orlistat (Xenical, Alli)
  • Phentermine-topiramate (Qsymia)
  • Semaglutide (Wegovy)
  • Setmelanotide (Imcivree)

What kind of weight loss medication is most effective?

Some popular examples of weight loss pills are Contrave (naltrexone/bupropion), Qsymia (phentermine/topiramate ER), and phentermine (Adipex-P). Some clinical studies suggest that Qsymia is the most effective weight loss pill.

How do I get semaglutide for $25 a month?

If you have private or commercial insurance, such as insurance you receive through an employer, you may be eligible to pay as little as $25 for a 1-, 2-, or 3-month prescription (maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription).

How much do you have to weigh to get prescribed Ozempic?

Those who have a body mass index (or BMI) of 30 or greater are eligible along with those who have a BMI of 27 or greater who also have other health problems such as high blood pressure, diabetes or high cholesterol that make weight loss important.

Is Ozempic approved for weight loss without diabetes?

Ozempic isn't approved for weight loss. But because of how it works, some people taking Ozempic lose weight as a side effect. If you don't have diabetes, taking Ozempic for weight loss is considered an off-label use.

Which is better Ozempic or Mounjaro?

Mounjaro reduced the A1C by 2% to 2.3% compared to a 1.9% reduction for participants in the semaglutide (Ozempic) 1 mg group. Mounjaro led to weight loss of 7.7 kg (17 lb) to 11.4 kg (25 lb), on average, compared to 5.9 kg (13 lb) for semaglutide (Ozempic).

Does everyone lose weight on Mounjaro?

After 72 weeks (that's just over 1 year and 4 months) of taking Mounjaro, half of participants taking 10 mg per week lost an average of 20% of their body weight. For the group taking 15 mg per week, 57% of participants lost an average of 20% of their body weight.

What is the best injection for weight loss?

Some of the most effective prescription injectable weight loss medications available include: Mounjaro, Ozempic and Wegovy - these are diabetes drugs originally and now used to treat obesity. Although these injectable drugs can help users lose weight there are some dangers and caveats!

What foods to avoid on Mounjaro?

Your healthcare provider can advise you on the best meal plan for you, based on your current medical conditions and history.
  • Fried and greasy foods. ...
  • Sugary foods. ...
  • Sodas and carbonated beverages. ...
  • Refined grains and carbohydrates. ...
  • High-glycemic fruits and vegetables. ...
  • Alcohol.

Do you gain weight back after stopping Mounjaro?

Unfortunately, it can be a lot easier to put weight back on than lose it in the first place. Stopping Mounjaro means there's a risk for you to regain back the pounds you lost on it.

Can I get Mounjaro without diabetes?

Tirzepatide (Mounjaro) is a medication approved for the treatment of type 2 diabetes, but it has shown incredible results for weight loss, even for people who do not have diabetes.

Is Wegovy just an appetite suppressant?

Ozempic and Wegovy are the same drug, semaglutide, but come in different doses. They work as appetite suppressants and help control blood sugar levels by prompting the body to release insulin.

Will my doctor prescribe Wegovy for weight loss?

“For prescribing Wegovy for weight loss, a person must have a body mass index (BMI) of 30 or greater. It's also approved for use in people with a BMI of 27 or greater, who have an accompanying overweight- or obesity-related condition, such as high blood pressure or sleep apnea,” Dr. Dominguez says.

What kind of weight loss can I expect with Wegovy?

In the 68-week studies: 83% of adults taking Wegovy lost 5% or more of their weight compared to 31% of people taking a placebo. 66% of adults taking Wegovy lost 10% or more of their weight compared to 12% of people taking a placebo.