Medicare now covers GLP-1 drugs like Wegovy and Zepbound for seniors through a new Centers for Medicare and Medicaid Services (CMS) program, with copays as low as $50 per month. This marks a major shift for weight-loss medications that previously cost $900 to $1,500 monthly out-of-pocket.
The catch centers on your deductible. Medicare Part D typically requires you to hit your annual deductible before copay protections kick in. For 2024, the standard Part D deductible is $545. If you haven't met it yet, you'll pay the full price of each dose until you do. That means your actual cost per injection could reach $200 to $300 before the $50 copay applies.
The math gets brutal fast. A single Wegovy or Zepbound injection costs roughly $200 to $250 at retail. If you start treatment in January with an unmet deductible, your first three to four injections could cost $600 to $1,000 total out-of-pocket before hitting the deductible and accessing the $50 copay tier.
Timing your treatment matters. Seniors approaching the end of the calendar year with high deductible balances may wait until January to start, when deductibles reset. Others might investigate whether their specific Medicare Part D plan offers deductible waivers for certain drugs. Some plans do. Most don't.
You'll need to confirm several things with your plan. First, verify that Wegovy or Zepbound appears on your formulary. Second, check whether your plan classifies the drug as Tier 3 (preferred brand) or Tier 4 (non-preferred brand). Tier 4 drugs carry higher copays. Third, ask explicitly about deduct