TRICARE ends weight-loss drug coverage for TRICARE For Life and other groups

The Defense Health Agency ended TRICARE coverage of weight-loss medications, including Zepbound (tirzepatide) and Wegovy (semaglutide), for TRICARE For Life and several other beneficiary groups effective Aug. 31, 2025 ^[1][2]. Prior authorizations for obesity drugs that had already been approved stopped being valid for those groups on the same date ^[2].

The groups that lost weight-loss drug coverage are TRICARE For Life beneficiaries, people with direct-care-only status, TRICARE Plus beneficiaries, foreign force members and NATO beneficiaries ^[1][2]. Coverage continues for people enrolled in TRICARE Prime, TRICARE Select, or a premium-based plan such as TRICARE Young Adult, TRICARE Reserve Select, TRICARE Retired Reserve, or the Continued Health Care Benefit Program, if they meet TRICARE's clinical criteria, have a prescription from a TRICARE network provider, and their provider submits a prior authorization ^[1]. The weight-loss drugs named in the coverage rules include Saxenda, Wegovy, Zepbound, Qsymia, phentermine and Contrave ^[1][3].

The agency described the change as putting existing federal rules into practice rather than writing new ones. TRICARE For Life offers Medicare wraparound coverage but follows different law and regulation than TRICARE Prime and TRICARE Select, and it is not authorized to cover weight-loss drugs when obesity is the sole or major condition treated, regardless of the patient's age ^[2]. Medicare Part D may cover certain weight-loss medications for non-obesity conditions such as sleep apnea or reducing cardiovascular risk, but TRICARE and Medicare operate under different legal frameworks, according to the agency ^[2].

"Many TFL beneficiaries have concerns about why some obesity treatments are covered and others aren't," said Edward C. Norton, chief of the Pharmacy Operations Division at the Defense Health Agency. "TFL coverage of these drugs isn't authorized when obesity is the sole or major condition treated" ^[2]. Defense Health Agency Chief Medical Officer Dr. Paul Cordts said it is important to understand how and why TRICARE covers these drugs based on a patient's condition and status ^[1].

Coverage for diabetes is handled separately. TRICARE covers Trulicity, Ozempic (semaglutide), Mounjaro (tirzepatide) and Victoza to treat type 2 diabetes, and that coverage continues for all patients with a diabetes diagnosis when prior authorization requirements are met, regardless of health plan ^[1][2][3]. Existing cost-shares for those medications have not changed ^[1].

Express Scripts, the TRICARE Pharmacy Program contractor, mailed notification letters to affected beneficiaries on July 31, 2025, 30 days before the change ^[2]. One TRICARE article told affected beneficiaries to expect a notice in the mail "in the coming weeks" ^[1]. The agency said affected beneficiaries should not stop taking their medication right away and should ask their provider what is appropriate during the transition ^[2]. How many people lost coverage has not been reported.

Why it matters for patients

For TRICARE For Life beneficiaries and the other excluded groups, an approved prior authorization for a weight-loss drug no longer results in a covered prescription. TRICARE will not cover the fill, and the agency said patients can discuss other treatment options with their provider or pay for the prescription out of pocket ^[2]. The size of that out-of-pocket cost has not been disclosed.

Coverage now depends as much on which TRICARE plan a patient has as on which drug is prescribed. A person with TRICARE Prime or TRICARE Select can still qualify for a weight-loss medication through prior authorization, while a person with TRICARE For Life taking the same drug for the same reason cannot ^[1][2].

A diabetes diagnosis is the main path that keeps GLP-1 coverage in place across plans ^[1][2]. TRICARE lists nutrition counseling, lifestyle and exercise changes, and other clinically appropriate approaches as options providers may discuss with patients whose weight-loss drug is not covered ^[1]. TRICARE directs beneficiaries to its formulary search tool to confirm whether a specific drug is covered and what forms are required ^[1][3].

What happens next

The Aug. 31, 2025 change is in effect, and prior authorizations for obesity medications are invalid for TRICARE For Life, direct-care-only, TRICARE Plus, foreign force and NATO beneficiaries ^[2]. TRICARE has not announced an exception process or a date for revisiting the policy. Beneficiaries can check drug status through the TRICARE Formulary Search Tool and confirm their drug's indication and prior authorization requirements with their provider ^[1][3]. No further milestones or deadlines have been reported.