Military Health System Limits GLP-1 Drug Access for Tricare Life Beneficiaries

Tricare has announced that certain retired service members and other eligible patients will soon see a loss of coverage for several popular weight loss medications within the military health system.

Starting August 31, Tricare for Life beneficiaries will see a change in their coverage, as GLP-1 drugs, such as Zepbound and Wegovy, and other comparable treatments will no longer be included, as stated in a Tuesday announcement. The alteration additionally impacts civilians within the Defense Department and others entitled to receive care at military hospitals who do not fall under the typical Tricare plans.

Active-duty members, retirees, and their families who are enrolled in plans such as Tricare Prime or Tricare Select will maintain their coverage, provided they meet specific medical criteria. To qualify, you must be enrolled in a premium plan, obtain prior authorization, and secure a prescription from a network provider. 

Tricare has not detailed the specific medical criteria required for coverage. Current approvals for weight loss medications will expire after Aug. 31, necessitating that patients consult their healthcare providers to explore other options.

The coverage for GLP-1 medications, such as Ozempic, Trulicity, Mounjaro, or Victoza, for the treatment of type 2 diabetes will continue as long as they are deemed medically necessary and receive prior approval. Certain medications for diabetes will continue to necessitate copayments.

The Defense Health Agency has yet to disclose an estimate regarding the number of individuals who will be affected. A report from the Military Health System released in January 2024 indicated a dramatic increase in prescriptions for weight loss medications among active-duty personnel, soaring nearly 100-fold from 1.2 to 104.4 per 100,000 members between 2018 and mid-2023. According to estimates from the CDC, the annual health care costs associated with obesity in the military could soar to $1.5 billion.

The decision aligns with actions taken by civilian insurers. Recently, CVS Caremark decided to discontinue coverage for Zepbound related to weight management, citing elevated costs as the primary reason. GLP-1 medications replicate hormones that control hunger and can cost between $700 and $800 per month.

“Insurers and policymakers are considering more than just the question, ‘Is this a good treatment?’” stated David Kim, a health economist from the University of Chicago. According to Kim, “Questions are being raised about the potential impact on our budget.”

Researchers at the University of Chicago estimate that increasing government coverage for weight loss medications could lead to an additional $48 billion in Medicare expenditures over the next decade.