Historically excluded weight-loss drugs by statute. March 2024 Wegovy CV indication and December 2024 Zepbound OSA indication created coverage pathways. April 2026 CMS guidance expanded the Wegovy pathway.
Type 2 diabetes coverage
Covered. Ozempic, Mounjaro, Trulicity widely covered on Part D formularies for T2D.
Weight management coverage
Excluded by statute for weight-loss indication. Wegovy and Zepbound not covered for weight management under Medicare Part D.
CV indication coverage
Coverage expanded April 2026. CMS guidance allows Part D plans to cover Wegovy for adults BMI ≥27 + established CVD under the March 2024 FDA CV indication. First material Part D coverage expansion for a weight-management GLP-1 since 2003.
OSA indication coverage
Coverage of Zepbound for OSA in beneficiaries BMI ≥30 + moderate-severe OSA being added across Part D plans through 2026.
Prior authorization (typical)
Medicare PA criteria for Wegovy under CV indication: BMI ≥27 + documented established CVD (prior MI, ischemic/hemorrhagic stroke, symptomatic PAD).
How to verify
Call member services on your card and ask: (1) Is [Wegovy/Zepbound/Ozempic/Mounjaro] on my formulary? (2) What tier? (3) PA criteria? (4) Expected copay? Document the date, rep's name, and any reference number.
Cash-pay alternative
If insurance is unworkable, see our price index. Our editor's pick NexLife runs $145–$215/mo flat-rate.