Due to current legislation regarding free weight release drug , Medicare Part D or Part C plans with drug coverage may only cover Zepbound for treating obstructive rest apnea ( OSA ) .
However , the Centers for Medicare & Medicaid Services ( CMS)is consideringexpanding reportage of weight departure medication starting in 2026 .
Does Original Medicare cover Zepbound?
Zepbound ( tirzepatide)is a brand - name hypodermic ( under the cutis ) injection that doctors ab initio prescribe for treat OSA . Since then , it has alsogained approvalfor weighting loss andmanagement . Generally , Medicare drug programme only cover treatments for certain conditions with approval from the Food and Drug Administration ( FDA ) . A person can get Zepbound through Medicare Part D or Part C plans with drug reporting to treat this condition .
However , although the FDA has also sinceapprovedZepbound for treating weight deprivation andweight management , Medicare continues to be veto from covering the drug when necessarydue tothe Medicare Prescription Drug , Improvement , and Modernization Act of 2003 .
Is Zepbound covered by Medicare Advantage plans?
A soul can sign up for Medicare Advantage ( Part C ) , an alternative to Original Medicare ( parts A and B ) . Some Part C program also offer drug coverage .
That said , like Part 500 plans , such plans have to adhere to the formula that only allows reportage of Zepbound for care for OSA .
How much does Zepbound cost with or without Medicare?
Zepbound can be more than$1,000out of air pocket , depending on the dispensing pharmacy . A person who does not restrict for coverage under their Medicare plan will have to pay the full cost .
The out - of - pocket monetary value for Zepbound under Medicare Part D or a Part C programme with drug coverage depends on the specific architectural plan . These privately managed architectural plan expend aformulary listto categorize drugs into level . high tier generally mean higher price .
These plans also usually admit a deductible and a monthly exchange premium . According to the CMS , the interior base donee premium for Part D in 2025 is$36.78 , while the mean monthly agio for Part C is about$17 .
What weight loss drugs will Medicare pay for?
more often than not , Medicare does not cover certain medications , such as glucagon - like peptide-1 ( GLP-1 ) sense organ agonists , for treating weight deprivation alone . That say , this may be shift . Currently , CMS is evaluating this policy , with potential changestaking effectin 2026 .
Additionally , after the FDAapproved Wegovy(Semaglutide ) for treating heart disease , including for those with corpulency or overweight , Medicare architectural plan may be able to incubate it for those whorequiretreatment for both heart disease and corpulency .
