GLP-1 drugs and Medicare Part D
Learn how GLP-1 drugs work, which conditions may qualify for coverage, and where to find information about your plan's covered medications.
What is a GLP-1 (glucagon-like peptide-1 inhibitor) drug?
GLP-1 drugs may help you:
- Control blood sugar
- Feel full longer
- Eat less
- Lose weight
These drugs are prescribed by a healthcare provider and work best when combined with healthy eating and regular physical activity.
What are the most common GLP-1 drugs?
- Foundayo™ (orfoglipron)
- Mounjaro® (tirzepatide, which works on GLP-1 and another hormone)
- Ozempic® (semaglutide)
- Trulicity® (dulaglutide)
- Wegovy® (semaglutide)
- Zepbound® (tirzepatide, which works on GLP-1 and another hormone)
Not all GLP-1 drugs are the same. These drugs may be approved for different health conditions and can vary in how they are prescribed and used. Your healthcare provider can help determine the most appropriate drug based on your individual health needs.
Does Medicare Part D (prescription drug coverage) cover GLP-1 drugs?
It depends. When prescribed solely to promote weight loss, Medicare Part D does not cover GLP-1 drugs.
Medicare Part D may cover GLP-1 drugs when prescribed for:
- Type 2 diabetes: a condition where a person has trouble controlling sugar in the blood
- Sleep apnea: a condition that causes a person to stop breathing for short periods during sleep
- MACE: to help lower the chance of a heart attack or stroke in adults with established heart or blood vessel disease and are obese/overweight
- MASH: a serious liver disease caused by too much fat building up in the liver
What if I do not have a condition covered through my Medicare Part D plan?
Drugs prescribed solely for weight loss are not covered under Medicare Part D. However, some Medicare beneficiaries may be eligible for the Medicare GLP-1 Bridge program, a CMS program that provides access to select GLP-1 drugs for eligible individuals who meet program requirements.
Visit the Centers for Medicare & Medicaid Services (CMS) website for more information about the Medicare GLP-1 Bridge program, including coverage and eligibility requirements.
If you have a condition that is eligible for coverage under Medicare Part D, you will not be eligible for the Medicare GLP-1 Bridge program.
How do I know which GLP-1 drugs are covered by my plan for Type 2 diabetes, sleep apnea, MACE, and MASH?
The first step is to have a conversation with your health care provider about your treatment goals. Together, you can decide whether a GLP-1 drug is appropriate and, if so, which option may be the best fit for you.
To support a conversation with your provider about a GLP-1 drug, you can review a list of your plan’s covered drugs.
If you have a question about your Medicare Part D prescription drug benefit, call the number on the back of your member card or contact Customer Care.
