The landscape of weight loss medications and their coverage under health insurance plans is constantly evolving. For TRICARE beneficiaries, understanding the specifics of coverage for weight loss injections, particularly Glucagon-Like Peptide 1 (GLP-1) drugs, is crucial. This article provides a comprehensive overview of TRICARE's policies, recent changes, and what beneficiaries need to know.
Recent Changes to TRICARE Coverage
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. These controls took effect Aug. 31, 2025. This change primarily affects those with TRICARE For Life (TFL) benefits.
Edward C. Norton, Chief, Pharmacy Operations Division at the Defense Health Agency, addressed concerns stating, “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."
TRICARE For Life (TFL) Coverage
TFL offers Medicare wraparound coverage, which operates under different legal frameworks compared to TRICARE Prime and TRICARE Select. Federal law doesn’t authorize TFL to cover weight loss medications when prescribed for weight loss as the sole or major condition.
A key distinction to remember is that TRICARE and Medicare operate under different legal frameworks with different coverage authorities. While Medicare Part D may cover certain weight loss medications for non-obesity conditions, TFL follows separate federal laws and regulations that exclude medications intended to control or reduce weight when obesity is the primary condition being treated.
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What Happens if You Try to Fill a Prescription After August 31?
If you are a TFL beneficiary and attempt to fill a prescription for weight loss medication after August 31, TRICARE will not cover your prescription. It is recommended to discuss alternative treatment options with your healthcare provider.
TRICARE Prime and TRICARE Select Coverage
If you are enrolled in TRICARE Prime or TRICARE Select, these medications are still covered in certain circumstances. TRICARE covers weight loss medication drugs (including GLP-1s) when you meet certain criteria, based on diagnosis, medical necessity, and your TRICARE plan.
GLP-1 Medications and Diabetes Treatment
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. TRICARE covers Trulicity, Ozempic, Mounjaro, and Victoza to treat type 2 diabetes. It's important to note that 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.
Prior Authorizations
Prior authorizations for obesity medications became invalid on Aug. 31, 2025. If you had an approved prior authorization for weight loss drugs, it’s no longer valid.
You can find specifics on TRICARE prior authorization requirements using the TRICARE Formulary Search tool.
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Weight Loss Medications: Wegovy and Zepbound
The FDA recently approved two drugs for weight management: Wegovy and Zepbound. These medications target areas of the brain that regulate appetite and food intake and are taken as weekly self-administered injections.
Health care providers may prescribe diabetes medications, Ozempic and Mounjaro, off-label to help people without diabetes lose weight, but the medications are not FDA-approved for this purpose.
Medicare and Commercial Health Plan Coverage
Medicare is currently prohibited by law from covering medications specifically used for weight management. However, a path for Medicare coverage opened recently when the FDA approved Wegovy to reduce risks associated with cardiovascular disease among those overweight or obese.
Commercial health plans often follow coverage policies established by Medicare, so there might be expanded and more consistent coverage of weight loss medications by commercial and employer-sponsored plans.
What to Do If Your Weight Loss Drug Isn’t Covered
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.
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The Importance of Healthy Habits
Forming healthy habits is crucial to maintaining a healthy weight.
TRICARE Formulary Search Tool
Use the TRICARE Formulary Search Tool to check your drug’s coverage and costs. This tool is essential for understanding coverage requirements and potential out-of-pocket expenses.
MOAA's Role
MOAA continues its work to protect your access to world-class care and will continue to monitor weight loss medication coverage policies to ensure TRICARE evolves to keep up with commercial plan benchmarks and other government payers.
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