Does TRICARE Cover Wegovy, Zepbound, and Other Medications Taken for Weight Loss

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It's hard to miss advertisements for medications taken for weight loss, such as Zepbound (tirzepatide) and Wegovy (semaglutide). These injectable weight-loss medications have been effective at helping people lose a significant amount of weight. But they can cost $1,000 to $1,200 per month.

If you're a TRICARE beneficiary, getting your injectable weight-loss medication covered depends on the healthcare program's criteria and your plan.

Does TRICARE cover weight-loss medication?

TRICARE, the federal health insurance for U.S. military members and their families, may cover some weight-loss medications if you meet their requirements. Certain FDA-approved Type 2 diabetes medications, such as Ozempic (semaglutide), can cause weight loss as a side effect and may be covered by TRICARE. But if you don't have diabetes and want to take these medications for weight loss, this is considered an off-label use. In this case, TRICARE is unlikely to provide coverage.

To be covered by TRICARE, prescription medications must be FDA approved for the health condition they're prescribed to treat.

In most cases, TRICARE requires a coverage review - or prior authorization - for injectable and oral weight-loss medications. You may need to try an oral weight-loss medication before TRICARE approves an injectable one. Rules limiting fills at retail pharmacies may also apply. Some medications may be available at military pharmacies, while others must be obtained through the TRICARE Pharmacy Home Delivery program.

Your costs depend on the medication tier on TRICARE's formulary, your plan, and how you obtain the medication - a military pharmacy, home delivery, or a retail pharmacy. For example, your copay for a brand-name medication that's on the formulary might be $38 through home delivery but $129 at a retail pharmacy.

Does TRICARE cover Ozempic?

TRICARE may cover Ozempic when prescribed to treat diabetes. Ozempic is an injectable medication that's FDA approved to treat Type 2 diabetes in adults. It can also reduce the risk of heart attack and stroke in people with Type 2 diabetes who have heart disease.

Ozempic is not FDA approved for weight loss. If you take Ozempic off-label for weight loss, TRICARE will not cover the medication. Without insurance or savings coupons, expect to pay $1,000 to $1,200 per month.

If a healthcare professional prescribes Ozempic, then TRICARE may cover it if you:

• Have Type 2 diabetes

• Can't take metformin for a medical reason

Ozempic must be approved through TRICARE's coverage review. To request coverage review, the prescriber must complete a prior authorization form.

Since Ozempic is a nonpreferred medication on TRICARE's formulary, the prescriber must also fill out a medical necessity form. This form tells TRICARE why you need Ozempic instead of a preferred medication. Your prescriber may also suggest Trulicity (dulaglutide) instead of Ozempic, since it's the preferred medication on TRICARE's formulary.

Does TRICARE cover Wegovy?

Wegovy, an FDA-approved medication for chronic weight management, may be covered by TRICARE. To get TRICARE to cover Wegovy, your prescriber must fill out a prior authorization form to request coverage review.

Here are the Wegovy prior authorization criteria if you're at least 18 years old:

• You have a body mass index (BMI) of 30 or higher. Or have a BMI of 27 or higher and one additional risk factor, such as diabetes, sleep apnea, or high blood pressure.

• You have tried and failed or can't take oral weight-loss medications, such as Qsymia (phentermine / topiramate), Contrave (naltrexone / bupropion), or one of their individual generic components.

• You have tried lifestyle changes, including diet and exercise, for at least 6 months without reaching your weight-loss goals.

• You commit to continuing healthy habits while using Wegovy.

If approved, your initial Wegovy coverage will last 6 months. After that, coverage can be renewed for 12 months at a time.

Wegovy has a list price of about $1,350 monthly, but retail prices may be higher depending on the pharmacy. Since Wegovy is on TRICARE's formulary list, active-duty military members can get the medication at no cost. Non-active-duty members pay the formulary copay.

Does TRICARE cover Mounjaro?

Similar to Ozempic, Mounjaro (tirzepatide) may be covered by TRICARE when it's prescribed to treat Type 2 diabetes. This injectable medication, used once a week, is FDA approved for managing blood glucose in adults with Type 2 diabetes. The price tag for Mounjaro is $1,000 to $1,200 monthly if you're paying out of pocket.

TRICARE will not cover Mounjaro for weight loss since the medication is not FDA approved for this purpose. If you're interested in tirzepatide - the active ingredient in Mounjaro - for chronic weight management, ask your prescriber about Zepbound. Zepbound contains tirzepatide and was approved by the FDA in November 2023 for weight loss in people without diabetes.

To get TRICARE to cover Mounjaro, you must meet certain requirements, such as:

• A diagnosis of Type 2 diabetes

• Unable to take metformin for health reasons

Mounjaro requires approval through TRICARE's coverage review process. To do so, the prescriber must submit a prior authorization form to TRICARE.

Mounjaro is a nonpreferred medication on TRICARE's formulary. This means the prescriber must also complete a medical necessity form. This form explains why you need Mounjaro instead of a preferred alternative.

Does TRICARE cover Zepbound?

Zepbound is FDA approved for chronic weight management in adults. The manufacturer's list price for a 28-day supply is $1,060. But you may pay more at the pharmacy without coupons. Zepbound may be covered by TRICARE if you meet the following requirements:

• You have a BMI of 30 or higher, or a BMI of 27 or higher plus a weight-related health issue.

• You have tried oral weight-loss medications, such as Qsymia, Contrave, or one of their generic components, but they didn't work (or you can't take these medications because of a medical reason).

• You have unsuccessfully tried to lose weight through diet and exercise for at least 6 months.

• You agree to keep up with healthy lifestyle changes while using Zepbound.

Zepbound must be approved through TRICARE's coverage review process. This means your prescriber must submit a prior authorization form to TRICARE. Similar to Wegovy, Zepbound approval is initially valid for 6 months. After that, your prescriber will need to renew the authorization every 12 months.

Zepbound is part of TRICARE's formulary list. If you're on active duty, you can get the medication for free. If you're not on active duty, you'll have a copay.

How to get weight-loss medications covered by TRICARE

Here's how to get TRICARE to cover weight-loss medications:

• Get a prescription: Discuss your medical condition with a healthcare professional. If they determine weight-loss medication is an option for you, they'll write you a prescription.

• Check medication coverage: Look up the medication on TRICARE's formulary. There, you can verify the coverage requirements. You may also call the TRICARE Pharmacy Program at 1-877-363-1303 if you're in the U.S. or at 1-866-275-4732 if you're outside the U.S.

• Collect supporting documentation: TRICARE will often require documentation of your past attempts at weight loss. This can include medical records, a food diary, and proof of participation in a weight-loss program. Your prescriber's office may be able to help you with this.

• Request approval: Your prescriber must submit a prior authorization request. For some medications, a medical necessity form is also needed.

• Get your medication: Once you're approved, fill your prescription at a military pharmacy. You can also use TRICARE Pharmacy Home Delivery or, in some cases, a network retail pharmacy.

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