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In response, CMS has proposed a reinterpretation of the statutory exclusion, distinguishing between drugs used for weight loss and those used for the treatment of obesity. This shift would allow Part D and state Medicaid coverage for anti-obesity medications (AOMs) prescribed specifically for obesity

Key Takeaways Medicare Part D excludes drugs used solely for weight loss, but coverage may be available for medications with FDA-approved medical uses beyond weight management GLP-1 drugs like Ozempic and Mounjaro can be covered for Type 2 diabetes, while Wegovy may be covered for cardiovascular risk reduction in qualifying patients Medicare Part B covers obesity counseling and behavioral therapy for beneficiaries with a BMI of 30 or higher when provided in primary care settings The 2025 Medicare Part D changes cap annual out-of-pocket costs at $2,000 for covered medications, significantly reducing patient expenses New pilot programs could potentially expand Medicare coverage for weight loss drugs starting as early as 2027 Medicares approach to weight loss medications creates confusion for millions of beneficiaries seeking help with weight management

This can be evaluated through an exercise stress test, where the ability to walk on a treadmill for 510 minutes without symptoms suggests good cardiovascular fitness

Important Safety Information: Ozempic is not for use in patients with type 1 diabetes or as a first-line therapy for type 2 diabetes