- TRICARE Prime and Select cover Wegovy and Zepbound with prior authorization
- Active duty service members typically have the lowest out-of-pocket medication costs
- TRICARE for Life no longer covers weight loss medications as of August 2025
- Prior authorization requires BMI criteria, documentation, and previous weight loss attempts
- Wegovy is covered for weight loss; Ozempic is only covered for type 2 diabetes
If you are a military service member, retiree, or family member with TRICARE, you may be wondering: does TRICARE cover Wegovy and Zepbound for weight loss? The answer is yes for most TRICARE plans, but there are important details to understand, especially after the policy changes that took effect in August 2025.
If you have TRICARE Prime, you must obtain a referral to “PEAK Wellness and Aesthetics” from your primary care manager (PCM) before scheduling an appointment. This applies even if you plan to self-pay. Without a referral, your visit may not be authorized under TRICARE Prime.
Which TRICARE Plans Cover Weight Loss Medications?
Covered (with prior authorization)
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Select
- TRICARE Reserve Select
- TRICARE Young Adult (Prime and Select)
If you are enrolled in one of these plans, Wegovy and Zepbound are covered for chronic weight management when you meet the clinical criteria and have an approved prior authorization.
Not Covered for Weight Loss
- TRICARE For Life (as of August 31, 2025)
- Individuals with direct care only access
- DoD civilians not enrolled in covered plans
The August 2025 change eliminated weight loss medication coverage for TRICARE For Life beneficiaries. However, TRICARE For Life still covers office visits at PEAK — the change only affects weight loss medications. If you have TFL, you would need to self-pay for medications or use manufacturer savings programs.
Self-pay rates for TFL beneficiaries: Initial visit $199 (includes EKG and lab review), follow-up visits $135, dietitian visits $75/session (required monthly for first 3 months). Office visits are covered by TFL.
TRICARE still covers Ozempic and Mounjaro for type 2 diabetes across all plans. The August 2025 change only affects weight loss medications.
Note: PEAK does not accept Medicare or Medicaid as primary insurance. TRICARE For Life beneficiaries are seen under their TRICARE benefit, not Medicare.
What Are the Prior Authorization Requirements?
To get TRICARE to cover Wegovy or Zepbound for weight loss, you must meet these criteria:
Clinical Requirements
- BMI of 30 or higher, OR
- BMI of 27 or higher with at least one weight-related condition (diabetes, hypertension, dyslipidemia, sleep apnea)
Documentation Requirements
- Prescription from a TRICARE-authorized network provider
- Prior authorization form completed by your provider
- Evidence of previous weight loss attempts (typically diet and exercise for at least 6 months)
- Commitment to continue healthy lifestyle habits while on medication
Initial approval period: 6 months. After 6 months, your provider must submit for reauthorization. You will typically need to demonstrate weight loss progress (usually at least 5% of starting body weight) for continued coverage. Reauthorization is valid for 12 months.
What Will You Pay?
If you have an approved prior authorization, your costs depend on your TRICARE plan and where you fill the prescription:
| TRICARE Plan | Retail Pharmacy (30-day) | Home Delivery (90-day) |
|---|---|---|
| Active Duty | Lowest out-of-pocket | Lowest out-of-pocket |
| Prime (non-active duty) | Lower out-of-pocket than most commercial plans | Lower out-of-pocket than most commercial plans |
| Select | Plan-based out-of-pocket | Plan-based out-of-pocket |
| TRICARE for Life | No longer covered (as of August 2025) | |
Note: Weight loss medications cannot be filled at military pharmacies. You will need to use a network retail pharmacy or Express Scripts home delivery.
These copays are significantly lower than commercial insurance or self-pay options, making TRICARE coverage a substantial benefit.
What Changed in August 2025?
The Defense Health Agency implemented regulatory controls on weight loss medication coverage effective August 31, 2025. The key changes:
- TRICARE For Life beneficiaries: No longer eligible for weight loss medication coverage
- Revised prior authorization criteria: Updated clinical criteria with more specific documentation requirements
- No military pharmacy fills: Weight loss drugs can no longer be filled at military pharmacies
- TRICARE Prime and Select: Coverage continues with prior authorization
Wegovy vs. Ozempic: An Important Distinction
Both Wegovy and Ozempic contain semaglutide, but TRICARE treats them differently:
| Medication | Approved For | TRICARE Coverage |
|---|---|---|
| Wegovy | Chronic weight management | Covered with PA (Prime/Select) |
| Ozempic | Type 2 diabetes | NOT covered for weight loss |
| Zepbound | Chronic weight management | Covered with PA (Prime/Select) |
| Mounjaro | Type 2 diabetes | Covered for diabetes only |
If you want GLP-1 medication for weight loss and you do not have diabetes, Wegovy or Zepbound is the appropriate prescription.
How PEAK Helps TRICARE Patients
As a TRICARE-authorized provider, we handle the administrative complexity so you can focus on your health:
- Complete your prior authorization — We submit PA forms to Express Scripts
- Handle reauthorizations — When your initial 6-month approval expires, we submit for renewal
- Appeal denials when appropriate — We file appeals with additional clinical justification
- Prescribe the right medication — FDA-approved weight loss medication only
- Provide ongoing care — Regular follow-up visits fulfill TRICARE supervision requirements
Frequently Asked Questions
Can I fill my prescription at the base pharmacy?
No. As of August 2025, weight loss medications cannot be filled at military pharmacies.
I have TRICARE For Life. What are my options?
TFL no longer covers weight loss medications, but your office visits at PEAK are still covered by TFL. For medications, your primary option is self-pay. Note that manufacturer savings cards (NovoCare for Wegovy, LillyDirect for Zepbound) typically exclude patients with government insurance, including TRICARE. However, if you are paying entirely out of pocket for the medication and not using any TRICARE pharmacy benefit, you may qualify for manufacturer savings programs — eligibility requirements vary, so check directly with the manufacturer. Contact us to discuss the best path for your situation.
How long does prior authorization take?
Typically 1 to 2 weeks. We track every submission and follow up proactively.
What if I am PCS-ing?
Your TRICARE coverage travels with you. We provide complete medical records to support a smooth transition.
Do I need to try other weight loss methods first?
Yes. TRICARE requires documentation of at least 6 months of lifestyle changes.
