Weight loss medications like Ozempic, Rybelsus, and Wegovy are making headlines—and your clients are taking notice. As these medications become more popular, Medicare beneficiaries will have questions about whether they’re covered and what their options are.
Understanding current Medicare coverage rules, proposed changes, and the latest FDA developments will help you confidently answer client questions and position yourself as a knowledgeable resource.
Let’s break down what you need to know about Medicare and weight loss medications in 2025.
Why Are Clients Asking About These Drugs?
GLP-1 medications like Wegovy and Ozempic were originally developed to treat diabetes but are now widely prescribed for weight loss.
With obesity affecting over 40% of American adults, many Medicare beneficiaries are interested in them.
Beyond weight loss, new research suggests these drugs may also:
- Reduce the risk of heart disease
- Help with alcohol cravings
- Improve sleep apnea
Because of these potential benefits, the demand for Medicare coverage is growing—but as of now, weight loss alone isn’t enough to qualify for coverage.
What Medicare Does Cover
- Medicare Part B covers obesity screenings and behavioral therapy for beneficiaries with a BMI of 30 or higher.
- Medicare Part D may cover GLP-1 medications like Ozempic—but only if prescribed for diabetes or another approved condition.
- Medicare does NOT cover weight loss drugs unless prescribed for another approved condition.
Talking point for clients:
"Right now, Medicare doesn’t cover Wegovy or other weight loss drugs, but if you have diabetes or another qualifying condition, some plans may cover similar medications. Let’s check your Part D formulary."
Related: 2025 Part D Updates & Carrier Highlights
Possible Future Changes in Coverage
Medicare coverage for weight loss drugs may expand soon.
In November 2024, President Biden proposed expanding Medicare coverage to include weight loss medications for obesity, potentially providing access to drugs like Wegovy and Zepbound for millions of Medicare and Medicaid beneficiaries (KFF).
However, the final decision now rests with the Trump administration, which has yet to announce its stance on the proposal.
Health plans are urging the Trump administration to reject it, arguing that expanded coverage would increase premiums for consumers, while supporters believe it could improve health outcomes and reduce long-term healthcare costs (The Street).
The decision is expected in April 2025.
Talking point for clients:
"There’s a push to expand Medicare coverage for weight loss drugs, but nothing has changed yet. We’ll keep an eye on this so you’ll know if new options become available."
How Price Negotiations Could Affect These Drugs
The Inflation Reduction Act allows Medicare to negotiate drug prices for the first time. Wegovy and Ozempic have been added to the price negotiation list, meaning we could see lower costs in the coming years.
But there’s a catch:
- Drugmakers have a month to decide if they want to negotiate.
- The Trump administration will have the final say on whether negotiations move forward.
- If negotiations happen, lower prices won’t take effect until 2027.
Talking point for clients:
"Medicare is working on lowering drug prices, including for some weight loss medications, but it won’t happen overnight. We should know more soon."
Compounded Versions of Wegovy & Ozempic Soon to Go
Compounded medications are only allowed when an FDA-approved drug is on the official shortage list.
Since the FDA declared the Ozempic and Wegovy shortage resolved on February 21, 2025, pharmacies must stop making compounded versions within 60–90 days, leaving only the brand-name options available.
What this means for your clients:
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Discontinuation of Compounded Versions: Patients obtaining compounded semaglutide may lose access by April 22, 2025 (for state-licensed pharmacies and physicians), or by May 22, 2025 (for outsourcing facilities).
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Potential Impact on Brand-Name Availability: The shift could increase demand for brand-name drugs like Ozempic and Wegovy, possibly affecting their availability and cost.
Talking Point for Clients
"If you've been using a compounded version of Ozempic or Wegovy, please note that these may not be available after April 22, 2025."
What Agents Should Watch for in 2025
With GLP-1 medications making headlines, staying informed is key.
As you can see, 2025 is bringing major shifts in Medicare coverage discussions, drug pricing, and access to these medications.
Keeping up with these changes will set you apart as a knowledgeable agent and help you provide valuable guidance to your clients.
MedicareCENTER
If Medicare starts covering weight loss drugs—or if your clients qualify for coverage due to another condition—MedicareCENTER makes it easy to compare costs and coverage options.
If you’re not already using it, now’s the time!
It’s free for contracted agents and helps you:
- Check Part D formularies for covered medications
- Compare plans for clients asking about weight loss drug coverage
- Track updates on policy changes in real time
Visit this page for MedicareCENTER training videos.
Conclusion
Medicare’s stance on weight loss drugs is shifting, and your clients will have questions.
Stay informed, be ready with the right answers, and make sure you’re equipped with the tools to help them navigate their options.
