Weight-loss drugs such as Wegovy, Zepbound, and other GLP-1 medications are no longer covered for TRICARE For Life (TFL) beneficiaries as of Aug. 31, though the other TRICARE plans continue to offer coverage, with prior authorization.
TRICARE policy has never approved coverage for GLP-1 drugs simply to lose weight or for cosmetic purposes. The prior authorization process requires documentation of comorbid medical conditions that can be improved or eliminated by taking GLP-1 medications.
Those prescribed GLP-1 drugs for Type 2 diabetes (Trulicity, Ozempic, Mounjaro, or Victoza) will be able to continue their treatment plans.
MOAA pushed for the Defense Health Agency (DHA) to delay the planned Aug. 31 coverage change, citing two key concerns echoed by hundreds of MOAA members and others who’ve shared their GLP-1 story:
- The move threatens the significant strides made by many GLP-1 users in reducing or eliminating weight-related ailments such as sleep apnea or high blood pressure while improving their quality of life.
- The change sets a dangerous precedent by creating two classes of drug coverage for TRICARE and TRICARE For Life beneficiaries. Future moves could widen this coverage difference, significantly weakening the TFL benefit.
[MOAA FAQ: TRICARE For Life and Weight-Loss Drugs]
Some examples from messages sent to MOAA:
“This is an extremely short-sighted change. It will be more expensive in the long run to deal with all the health problems associated with obesity.”
“Zepbound has made such a great difference in my life that I can’t imagine going back.”
“Any [TRICARE For Life] beneficiary deserves full benefits the same as any TRICARE beneficiary.”
[RELATED: Bipartisan Bill Would Close Unfair TRICARE Young Adult Coverage Gap]
MOAA’s work on the issue, which has received national media attention, will continue on multiple fronts, as we engage DoD health officials and lawmakers. Much of that work involves research into TRICARE’s legislative and regulatory history, as a means to better understand the DHA’s claim that TFL coverage of weight-loss medication is “inconsistent with existing statutory and regulatory authority.”
While the patchwork of statute and regulations involving TRICARE coverage of weight-loss treatments is complex, MOAA has not discovered any federal statute specifically excluding TFL beneficiaries from coverage of GLP-1 drugs or other treatments. There are, however, multiple instances of federal statute requiring a uniform pharmacy program benefit across all TRICARE categories — instances which appear to run counter to the recent GLP-1 ruling. As we present these arguments to lawmakers and DoD officials alike, we will advocate for updated federal regulations to preserve the TFL benefit and continue coverage parity for GLP-1 drugs and in future coverage decisions.
Ensuring world-class coverage for all TRICARE beneficiaries, regardless of age, remains at the heart of MOAA’s mission. Keep up with the latest progress on this and other key issues at MOAA’s news page.
Share Your Story
MOAA’s advocacy relies on the testimony and experiences of service members and families impacted by changes to TRICARE policy. Will you, or someone you know, be affected by this change in TRICARE For Life coverage? Please share your story through Legislative Action Center at the link below.