instructions - enrollments for rx plans

WEIGHT LOSS MEDICATIONS UNDER MEDICARE

We would like to address the inquiries we’ve received regarding the coverage and accessibility of certain medications such as Ozempic and Wegovy (Semaglutide), Saxenda and Victoza (Liraglutide), and Zepbound and Mounjaro (Tirzepatide).

Unfortunately, Medicare does not currently cover these medications for weight loss. These medications are only approved under Medicare for the treatment of diabetes, and their use requires prior authorization.

Understanding Prior Authorization for Diabetes Treatment
If you are prescribed these medications for diabetes, the process includes:

1. Your doctor writes the prescription.
2. Your doctor submitting clinical notes and a prior authorization request to your insurance company.
3. Approval of the prior authorization by the insurance company, which then allows the pharmacy to dispense the medication.

To reduce potential delays, you may wish to discuss with your doctor the possibility of initiating the prior authorization process before submitting your prescription to the pharmacy.  What doctor’s wish patients knew

Alternative Options
While Medicare does not cover these medications for weight loss, we understand that many individuals are seeking alternatives. Some of our clients have shared information about vendors that provide alternative options. Please note, however, that we are not endorsing or recommending these options. We are simply passing along this information for your consideration.

Best Weight Loss Medications Of 2025

(click on this link above for 9 different options or below)

If you have further questions or need assistance, please don’t hesitate to reach out to us.

 Everyone is eligible for Medicare at 65,  but because people going onto Medicare are usually coming off of an Employer's plan and sometimes even keeping that other insurance—it can be complicated. Knowing the nuances will help you   

See Page 6 & 12  in the Who Pays First Booklet by clicking on the buttom below