When Congress created the Part D benefit, it excluded "agents when used for weight loss" by statute, and that still stands in 2026. So even though Zepbound is FDA-approved and effective, a Part D plan generally cannot pay for it when the purpose is weight management. This is a legal rule, not a medical-necessity judgment — which is why it applies across nearly every plan.
In late 2024 the FDA approved Zepbound to treat moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. Because that's a medical condition rather than "weight loss," Medicare Part D can cover Zepbound for that indication — and that's largely what the small share of plans listing it are covering. If you've been diagnosed with OSA, it's worth asking your plan and prescriber whether you qualify under that use.
It's the same molecule (tirzepatide), but Mounjaro is the version approved for type 2 diabetes — and it's covered on roughly 99% of Part D plans. The branding determines the approved use, and the approved use determines coverage. See the Mounjaro breakdown →
See how any medication lands across all Medicare Part D plans — coverage, tier, and prior authorization.
Look up a drug — freeOnly if the law changes. As of 2026 the statutory exclusion on weight-loss drugs remains, so coverage is limited to other approved uses such as obstructive sleep apnea.
It can. After the 2024 FDA approval for obstructive sleep apnea, some Part D plans cover Zepbound for that indication — typically on a high specialty tier with prior authorization. Ask your plan whether you qualify.
The list price runs well over $1,000 per month. If your plan won't cover it, ask your prescriber about manufacturer savings programs (often limited for people on Medicare) or a covered alternative.
Yes. Wegovy (semaglutide for weight loss) hits the same statutory exclusion and is on only about 1% of Part D plans. More on Wegovy →