Are you a TRICARE beneficiary taking a drug for weight loss, such as a GLP-1 medication like Zepbound or Wegovy? It's important to understand the differences between TRICARE plans and coverage to know what to expect when filling your prescription.
Current TRICARE Coverage for Weight Loss Medications
TRICARE covers weight loss medication drugs (including GLP-1s) when you meet certain criteria, based on diagnosis, medical necessity, and your TRICARE plan. If you are enrolled in TRICARE Prime or TRICARE Select, or get these benefits from a premium-based plan, these medications are still covered in certain circumstances. These beneficiaries still must have prior authorizations for the weight-loss drugs.
Weight loss medications must be:
- Prescribed by a TRICARE-authorized provider, including those at a military hospital or clinic.
- Filled at a TRICARE network pharmacy.
To check costs and coverage requirements, use the TRICARE Formulary Search Tool to search for your drug and find any required forms.
Upcoming Changes to TRICARE For Life (TFL) Coverage
The Defense Health Agency is implementing regulatory controls on weight loss medication coverage. These controls take effect Aug. 31, 2025. A new policy takes effect Aug. 31 for Wegovy, Zepbound, Saxenda, Qsymia, Phentermine and Contrave, affecting coverage of those drugs for weight-loss purposes.
Read also: Benefits of couples massage detailed
As of August 31, 2025, coverage for weight loss medications will no longer be available for non-TRICARE Prime and non-TRICARE Select beneficiaries.
TRICARE For Life is the TRICARE plan for Medicare-eligible military retirees and their Medicare-eligible family members.
Defense Health Agency officials contend the change corrects unauthorized coverage that Tricare has been providing to beneficiaries who weren’t eligible for the weight-loss medications. According to Tricare officials, Tricare has been providing coverage for weight loss medications to beneficiaries who were not eligible under federal statute.
Edward C. Norton, Chief, Pharmacy Operations Division at the Defense Health Agency, said, “Many TFL beneficiaries have concerns about why some obesity treatments are covered and others aren’t. TFL coverage of these drugs isn’t authorized when obesity is the sole or major condition treated. TFL offers Medicare wraparound coverage. Federal law doesn’t authorize TFL to cover weight loss medications when prescribed for weight loss as the sole or major condition.”
Different laws govern TRICARE Prime and TRICARE Select. According to Campbell, these laws allow DOD to offer certain health care services and health benefits when received from network providers under those plan options that are not available to [Tricare for Life] beneficiaries. Some Tricare for Life beneficiaries were found to have received coverage for these medications inconsistent with existing statutory and regulatory authority.
Read also: How digestive health affects weight loss
Impact on Beneficiaries
Just a few days before coverage for weight-loss drugs is set to end for Tricare for Life beneficiaries, advocates are calling on the Defense Health Agency and lawmakers to halt those plans. According to Ruedisueli, halting this policy change would provide time to assess the legislative and regulatory history governing Tricare policy on weight loss medications and determine next steps to avert negative impacts to beneficiaries.
Since the change in coverage was announced, MOAA has received a considerable amount of feedback from its members, all of whom went through extensive prior authorization processes to document co-morbid conditions, lifestyle changes and trials of alternative medications before they met the clinical criteria for approval for the weight-loss medications. The members are worried their progress will be reversed if they can no longer use these drugs.
According to Ruedisueli, a physician from Walter Reed National Military Medical Center also reached out to MOAA with concerns about the new policy and its impact on Walter Reed’s military retiree patients. And members who aren’t directly affected have another concern: that the change represents a terrible precedent and could lead to further targeted cuts to Tricare for Life. MOAA shares that concern.
Patients affected by the change should receive a notice from TRICARE in the coming weeks.
Example of Impact
One beneficiary received a letter from Tricare stated she could continue filling her current prescription - and pay 100% of the drug cost, which amounts to $1,300 per month. She said, “That will take most of our retirement money.”
Read also: Weight Loss Meds & BCBS
TRICARE Coverage for Diabetes Medications
GLP-1 drugs approved by the Food and Drug Administration for the treatment of diabetes will continue to be covered for all patients who have a diabetes diagnosis, when medically necessary and when prior authorization requirements are met, according to Tricare officials.
TRICARE covers Trulicity, Ozempic, Mounjaro, and Victoza to treat type 2 diabetes, with prior authorization. Ozempic, Mounjaro and Victoza require medical necessity forms for a formulary copayment and coverage at a military pharmacy, officials stated.
Note: GLP-1s for the treatment of diabetes continue to be covered for all patients with a diagnosis of diabetes when medically necessary and when prior authorization requirements are met.
Seeking Alternatives and Further Information
If your weight loss drug isn’t covered, you should speak with your provider about other options. Your provider can work with you to explore all options and determine the best approach for your health needs.
Officials are urging beneficiaries to talk to their health care providers about their options and suggest using the Tricare Formulary Search Tool to check costs and coverage requirements. Visit Does TRICARE cover Wegovy, Ozempic, and Mounjaro?
Remember: Forming healthy habits is crucial to maintaining a healthy weight.
Key Takeaways
- TRICARE covers weight loss medications for certain beneficiary groups, primarily those enrolled in TRICARE Prime or TRICARE Select.
- Coverage for weight loss medications for TRICARE For Life beneficiaries is ending on August 31, 2025.
- GLP-1 drugs for the treatment of diabetes continue to be covered for all patients with a diagnosis of diabetes when medically necessary and when prior authorization requirements are met.
- It is important to consult with your healthcare provider to explore all available options and determine the best approach for your health needs.
- Use the TRICARE Formulary Search Tool to check your drug’s coverage and costs.
TRICARE's Rationale for the Change
The Defense Health Agency recently announced it will implement existing regulatory controls regarding TRICARE coverage of weight loss medications, including Glucagon-Like Peptide 1 (GLP-1) drugs, to ensure prescription processing aligns with federal coverage requirements.
In the Aug. 5 announcement of the change, Defense Health Agency Chief Medical Officer Dr. Paul Cordts said “people are taking GLP-1 drugs - like Wegovy and Zepbound - for weight loss now more than ever.
Questions and Answers Regarding the Change
Q: I’m a TFL beneficiary. What happens if I try to fill my prescription after Aug. 31?
A: TRICARE will not cover your prescription. You can talk to your provider about other treatment options.
Q: I have TFL and diabetes.
A: It depends. TRICARE covers certain GLP-1s for the treatment of type 2 diabetes. Coverage continues for all patients with a diagnosis of diabetes when prior authorization criteria are met. We know this may be difficult. We encourage you to work closely with your provider.
Q: Which prior authorizations became invalid on Aug?
A: Prior authorizations for obesity medications became invalid on Aug.
Q: Why is TRICARE making this change?
A: TRICARE and Medicare operate under different legal frameworks with different coverage authorities. Medicare Part D may cover certain weight loss medications for non-obesity conditions. TFL follows separate federal laws and regulations. These laws and regulations exclude medications intended to control or reduce weight.
tags: #tricare #weight #loss #medication #coverage