GLP-1 Drugs and Medicare: What Part D Covers, What It Doesn't (2026)
By Sarah Mitchell, PharmD · May 20, 2026 · Drug pricing verified May 2026 against CMS guidance and manufacturer pages
Medicare patients CANNOT use manufacturer savings cards. That is federal law. What Medicare Part D covers depends on your drug and its indication. Ozempic and Mounjaro for type 2 diabetes ARE covered by most Part D plans. Wegovy for weight loss is NOT covered by Part D as of 2026 (Medicare excludes weight-loss drugs). Alternatives: Patient Assistance Programs or telehealth compounded semaglutide.
What saves you money
- +Ozempic and Mounjaro: covered by most Part D plans
- +Patient Assistance Programs: free drug for qualifying low-income patients
- +Telehealth compounded GLP-1: $100-250/month, no Medicare needed
- +Extra Help / LIS: reduces Part D costs to $10-$45/month if you qualify
Watch out for
- !Manufacturer savings cards are illegal for Medicare patients
- !Wegovy and Zepbound: NOT covered by Part D (weight-loss exclusion)
- !Part D cost-sharing for covered drugs can still reach $40-$180/month
- !Telehealth compounded drugs are not FDA-approved brand-name products
Check your specific Part D plan formulary at medicare.gov/plan-compare before filling any GLP-1 prescription.
Novo Nordisk and Eli Lilly offer savings cards that can cut the cost of GLP-1 medications to as little as $0 per month for eligible patients. But those cards exist for commercially insured patients only. If you are on Medicare, you cannot use them. That is not a policy decision by the manufacturers. It is federal law.
The law at issue is the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)). It prohibits drug companies from offering anything of value to a beneficiary of a federal health program to influence that person's drug choices. Manufacturer copay cards count as something of value. So Medicare patients are locked out.
That does not mean you are stuck with the full retail price. Your options depend on which drug you need, why you need it, and your income. This page covers all of them clearly, starting with what Part D actually pays for and ending with the alternatives that can make these drugs affordable.
If you landed here because your pharmacy told you the savings card was rejected, that is a common experience. The good news is there are real paths forward. Read on.
Why can't Medicare patients use savings cards?
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) prohibits offering anything of value to a Medicare or Medicaid patient to induce the purchase of a drug. Manufacturer copay cards work by subsidizing the patient's share of the cost. For a Medicare patient, that subsidy could steer them toward a more expensive brand-name drug instead of a generic. That is exactly the behavior the law is designed to prevent.
Violating this law can result in criminal charges for both the manufacturer and, in theory, the patient. Manufacturers enforce the restriction to stay compliant. The bar applies to Medicare, Medicaid, CHIP, TRICARE, and VA coverage. If any of your drug coverage comes from a federal program, manufacturer GLP-1 savings cards do not apply to you.
This is not a loophole that can be worked around. If a pharmacy or a third-party app tells you there is a way to apply the card anyway, that advice is legally risky. Use the legitimate alternatives described below.
What does Medicare Part D cover?
Coverage depends on what the drug is approved to treat. The same active ingredient in two different drugs can have very different Medicare coverage status.
| Drug | Indication | Medicare Part D Coverage (2026) |
|---|---|---|
| Ozempic (semaglutide) | Type 2 diabetes | Covered by most Part D plans. Tier 3-4. Check your plan formulary. |
| Wegovy (semaglutide) | Weight management / obesity | NOT covered. Medicare Part D excludes weight-loss drugs by law. |
| Mounjaro (tirzepatide) | Type 2 diabetes | Covered by most Part D plans. Tier 3-4. Check your plan formulary. |
| Zepbound (tirzepatide) | Weight management / obesity | NOT covered. Same Medicare weight-loss exclusion. |
Source: CMS Medicare Part D formulary guidance. Always confirm your specific plan formulary at medicare.gov/plan-compare.
What does Part D cost for Ozempic and Mounjaro?
Even when Part D covers a GLP-1 drug, there is still significant cost-sharing. Ozempic and Mounjaro are typically Tier 3 or Tier 4 specialty drugs on Part D formularies. Copays range from $40 to $180 per month before you hit your annual deductible, and costs can be higher while you are in the coverage gap (sometimes called the donut hole).
The Inflation Reduction Act (2022) capped insulin at $35 per month for Medicare patients. That cap does not apply to GLP-1 drugs. There is no similar legislative cap on GLP-1 cost-sharing as of 2026.
The Part D out-of-pocket cap (effective January 2025) limits total annual drug costs to $2,000 for covered drugs. Once you hit that cap in a calendar year, your copays drop to $0 for covered drugs for the rest of the year. This is a meaningful protection for patients on high-cost specialty drugs like Ozempic.
If the $2,000 annual figure still feels unaffordable, see the Patient Assistance Program and Extra Help sections below.
Patient Assistance Programs (PAPs) for Medicare patients
Both Novo Nordisk and Eli Lilly offer PAPs for qualifying low-income Medicare patients who cannot afford their drugs. These programs provide the drug for free or at very low cost directly from the manufacturer.
Novo Nordisk runs the NovoCare Patient Assistance Program. You can apply at novonordisk-us.com or call 1-844-668-6463. Eli Lilly runs the LillyCares Foundation. Apply at lillycares.com or call 1-800-545-5979.
Income requirements apply. Both programs typically serve patients below 400 to 600 percent of the federal poverty level. Your doctor must submit the application on your behalf. Processing can take two to six weeks.
PAPs are the best path for Medicare patients who need the brand-name drug and cannot afford Part D cost-sharing. Start the application before your current supply runs out.
Telehealth compounded GLP-1: does Medicare cover it?
Compounded semaglutide and tirzepatide from telehealth providers are not covered by Medicare because they are not FDA-approved drugs. But they cost $100 to $250 per month out of pocket, which is far less than Part D cost-sharing for brand-name drugs in many plans. Medicare patients who do not qualify for PAPs may find telehealth compounded options more affordable as a self-pay option.
These are not FDA-approved brand-name products. Discuss compounded GLP-1 options with your doctor before starting. Quality can vary by compounding pharmacy.
| Program | Drug | Est. Monthly Cost | Medicare Covered? |
|---|---|---|---|
| Henry Meds | Compounded semaglutide | ~$199/mo | No (self-pay) |
| Ro Body | Compounded semaglutide / tirzepatide | $145-220/mo | No (self-pay) |
Affiliate disclosure: some links may earn commissions at no extra cost to you. Prices change. Verify with each program before enrolling.
If you have both Medicare and Medicaid
Dual-eligible patients (those with both Medicare and Medicaid) are often automatically enrolled in Extra Help / Low Income Subsidy (LIS), which reduces Part D drug costs significantly. In 2026, Extra Help can reduce Tier 3 and Tier 4 drug copays to $10 to $45 per month, and eliminates the Part D deductible and premium for many enrollees.
If you are not already enrolled in Extra Help, apply at ssa.gov/benefits/medicare/prescriptionhelp.html or call Social Security at 1-800-772-1213. There is no cost to apply and no deadline.
Primary Sources
Frequently Asked Questions
Can I use the Wegovy savings card if I am on Medicare?
No. Federal law bars Medicare patients from using manufacturer savings cards. This applies to all brand-name GLP-1 savings cards from Novo Nordisk and Eli Lilly.
Does Medicare cover Ozempic?
Yes, Ozempic (semaglutide for type 2 diabetes) is covered by most Medicare Part D plans. It is typically a Tier 3 or Tier 4 specialty drug. Your cost depends on your specific plan formulary. Check your plan at medicare.gov/plan-compare.
Does Medicare cover Wegovy for weight loss?
No. Medicare Part D is prohibited by law from covering drugs used for weight gain or loss (42 U.S.C. § 1395w-102(e)(2)). Wegovy and Zepbound are indicated for obesity management, which puts them in this excluded category. There is ongoing Congressional discussion about changing this exclusion, but as of 2026, it remains law.
What is Extra Help for Medicare drug costs?
Extra Help (also called Low Income Subsidy or LIS) is a federal program that reduces or eliminates Part D drug premiums, deductibles, and copays for qualifying low-income Medicare enrollees. In 2026, Extra Help can reduce Tier 3/4 drug costs to $10-$45/month. Apply at ssa.gov or call Social Security at 1-800-772-1213.
Can I use a GoodRx coupon as a Medicare patient?
Using GoodRx at a pharmacy means you are paying cash, not using Medicare. This is allowed. Some Medicare patients compare their Part D copay versus the GoodRx cash price and choose whichever is lower. You cannot use both simultaneously. Using GoodRx means Medicare does not count that fill toward your deductible or out-of-pocket cap.
What is the Medicare Part D $2,000 out-of-pocket cap?
Starting January 2025, Medicare Part D has a $2,000 annual out-of-pocket maximum for covered drugs. Once you spend $2,000 on covered drugs in a year, your copays drop to $0 for the rest of the year. Note: only covered drugs count. GoodRx cash purchases and non-covered drugs do not count toward this cap.
Does Medicare Advantage (Part C) cover Wegovy or GLP-1 drugs?
Medicare Advantage plans are required to cover at least as many drugs as traditional Part D, so the weight-loss exclusion still applies. However, some Medicare Advantage plans may offer supplemental benefits related to weight management such as gym memberships or nutritional counseling. Check your specific plan's Evidence of Coverage document.
Is there any way to get Wegovy or Zepbound cheaper as a Medicare patient?
The main options are: (1) Patient Assistance Programs from Novo Nordisk or Eli Lilly if you qualify by income. (2) Telehealth compounded semaglutide or tirzepatide at $100-250/month. These are not FDA-approved brand drugs. (3) Wait and see if Congress lifts the Medicare weight-loss drug exclusion.