By MOAA Staff; last update Sept. 3.

 

Weight-loss drugs are no longer covered for TRICARE For Life (TFL) beneficiaries as of Aug. 31 – a policy change that has left many beneficiaries with questions regarding their care.

 

Answers to some of the more common questions can be found below. This page will be updated as more information becomes available. Keep up with the latest on this issue and others via MOAA’s news page.

 

Q. Will I lose coverage for my medication?

A. TFL beneficiaries prescribed a GLP-1 medication for weight loss – such as Wegovy, Zepbound, Saxenda, Qsymia, Phentermine, or Contrave – no longer have that medication covered as of Aug. 31. They must pay 100% of the cost of the weight loss drug as of that date, even if they have an approved prior authorization.

TFL beneficiaries who have been prescribed a GLP-1 medication for Type 2 diabetes – such as Ozempic, Mounjaro, or Victoza – will maintain their coverage.

Q. Why has my coverage changed?

A. The change is part of the Defense Health Agency’s implementation of “regulatory controls on weight loss medication coverage,” according to an Aug. 5 TRICARE.mil article. Direct-care recipients and some other, smaller, coverage pools also saw their coverage removed as a result of the implementation.

You are not impacted by this change if you are enrolled in any of the following plans:

• TRICARE Prime
• TRICARE Select
• TRICARE Young Adult
• TRICARE Reserve Select
• TRICARE Retired Reserve
• Continued Health Care Benefit Program
  
  
  

Q. Who should I contact with follow-up questions about my coverage, diagnosis, or prescription?

A. Your provider may be able to offer alternative treatment options. Questions about specific medicines or prescriptions can be directed to Express Scripts.


Q. What is MOAA doing about this change to my coverage?

A. MOAA is researching legislative and regulatory history on TRICARE’s weight loss medication restrictions as a first step in developing a response.

Q. How much will my weight loss drug cost if I have to pay for it out of pocket?

A. Costs vary widely based on a variety of factors, to include dosage size, drug type, where the drug is being purchased, and whether the user is eligible for any savings plans or other insurance products. MOAA cannot recommend a specific provider or retail outlet, but the manufacturers of GLP-1 weight loss medications do provide some pricing information.

• Wegovy: Manufacturer NovoCare offers an online form to check potential pricing.
• Zepbound: Manufacturer Eli Lilly outlines pricing options and possible savings plans.
• Saxenda: Manufacturer NovoCare offers an online form to check potential pricing.