Does TRICARE Cover Semaglutide? Ozempic, Wegovy, and Prior Authorization

TRICARE does cover semaglutide, but the terms depend entirely on why it is prescribed. For type 2 diabetes, Ozempic is covered under every TRICARE plan at standard pharmacy copays once a prior authorization is approved. For weight loss, Wegovy is covered only for beneficiaries in certain plans, and even those beneficiaries pay 100% of the drug’s cost out of pocket. Several groups, including TRICARE For Life enrollees, lost weight-loss drug coverage entirely on August 31, 2025.¹²

Ozempic for Type 2 Diabetes

All TRICARE beneficiaries can get Ozempic covered when it is prescribed to treat type 2 diabetes. The prescription must be deemed medically necessary, and the prescribing provider has to submit a prior authorization form and a medical necessity form to Express Scripts, TRICARE’s pharmacy contractor, before the pharmacy will fill it. The August 2025 policy revisions did not change copays or cost-shares for diabetes medications.²

As of January 1, 2026, the standard pharmacy copays that apply to Ozempic are:

Military pharmacy: $0 for all drugs.
TRICARE Home Delivery, up to a 90-day supply: $14 generic formulary, $44 brand-name formulary, $85 non-formulary.
Retail network pharmacy, up to a 30-day supply: $16 generic, $48 brand-name, $85 non-formulary.

Active-duty service members pay $0 at all three points of sale.³⁴

Wegovy for Weight Loss

Wegovy is on the TRICARE formulary, but the coverage is unusual: even with an approved prior authorization from an eligible plan, the beneficiary pays 100% of the drug’s cost. TRICARE does not publish a set price for Wegovy and does not indicate that it negotiates a discount on weight-loss drugs. Express Scripts (877-363-1303) is the point of contact for pricing.²

Whether a prior authorization is even possible depends on the plan. Eligible plans include:

TRICARE Prime, Prime Remote, Prime Overseas, Prime Remote Overseas, US Family Health Plan, and TRICARE Young Adult-Prime.
TRICARE Select, Select Overseas, Reserve Select, Retired Reserve, TRICARE Young Adult-Select, and the Continued Health Care Benefit Program.

Three groups are excluded from weight-loss drug coverage entirely: TRICARE For Life beneficiaries, beneficiaries with direct-care-only access at military hospitals and clinics, and beneficiaries with NATO or Partnership for Peace Agreement status. Those beneficiaries cannot fill Wegovy prescriptions at military pharmacies and pay the full cost anywhere else.¹

What Changed on August 31, 2025

On that date the Defense Health Agency implemented revised prior authorization criteria and new regulatory controls for weight-loss medications under 32 CFR Section 199.17(f)(3). The regulation authorizes obesity treatment when obesity is the sole or major condition treated, but only under TRICARE Prime and TRICARE Select, which is why TFL and direct-care-only beneficiaries fall outside coverage.⁵

Every prior authorization for a weight-loss drug that existed before that date became invalid. Beneficiaries who still qualify under their plan must get a new authorization; those whose plans were pushed out of coverage were directed to their providers to discuss nutrition counseling or other approaches. Coverage was also narrowed to cases where obesity is the “sole or major condition treated,” and the prescription must be written by a TRICARE network provider and filled at a network pharmacy.⁶⁷

Clinical Criteria a Prescriber Must Meet for Wegovy

The TRICARE Formulary lists specific requirements for Wegovy authorization. For adults 18 and older:

BMI of 30 or higher qualifies regardless of other conditions.
BMI between 27 and 29 qualifies only with at least one weight-related comorbidity, such as type 2 diabetes, impaired glucose tolerance, sleep apnea, osteoarthritis, metabolic syndrome, dyslipidemia, hypertension, MASH, or cardiovascular disease.
BMI below 27 does not qualify.

Adults must also document at least six months of behavioral modification and dietary restriction without reaching their weight goal, and they face a step-therapy requirement: at least three months on a generic stimulant such as phentermine, benzphetamine, diethylpropion, or phendimetrazine with a failure to lose 5% of baseline weight, or a documented contraindication or adverse reaction to those drugs.⁸

Adolescents ages 12 to 17 qualify with a BMI at or above the 95th percentile for age and sex. The criteria do not require the stimulant step therapy for adolescents.

Renewal is not automatic. Adults must show at least a 5% loss from baseline body weight since starting the full dose, and adolescents must show at least a 4% loss, with continued engagement in behavioral modification and a reduced-calorie diet.⁸

Getting Prior Authorization Approved

The process works the same way for Ozempic and Wegovy:

Use the TRICARE Formulary Search on the Express Scripts site to confirm the prior authorization requirement and download the form.
Give the form to the prescribing provider, who submits it to Express Scripts by mail, phone, fax, or through the electronic prior authorization (ePA) system.
Wait for the decision. Express Scripts typically processes requests in about 10 days, using criteria set by the Department of Defense Pharmacy and Therapeutics Committee.
Once approved, fill the prescription at a military pharmacy, a network retail pharmacy, or through TRICARE Home Delivery.

If Express Scripts denies the request, it notifies both the patient and the provider, and the denial letter explains the appeal path. Patients can also switch to a different covered medication or pay out of pocket. Formal pharmacy appeals go through TRICARE’s appeals process, with instructions included in the denial notification.⁹¹⁰¹¹

A Note for TRICARE For Life Beneficiaries

Retirees on TRICARE For Life sometimes assume Medicare will fill the gap. It doesn’t fill it the way many expect. TFL is not authorized to cover weight-loss medications when obesity is the sole or major condition being treated, at any age and regardless of comorbidities. Medicare Part D excludes drugs used solely for weight loss but may cover certain GLP-1s for non-obesity indications, such as Wegovy for cardiovascular risk reduction in adults with heart disease who are overweight or obese, or Ozempic for blood sugar control in type 2 diabetes. TRICARE and Medicare operate under different statutes, and TFL does not adopt Medicare’s exceptions.¹²

1
TRICARE. Weight Loss Products
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TRICARE. Does TRICARE Cover Wegovy, Ozempic, and Mounjaro
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TRICARE Newsroom. Preview Your 2026 TRICARE Pharmacy Costs
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Express Scripts. Changes to Your TRICARE Prescription Drug Copayments in 2026
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eCFR. 32 CFR 199.17 – TRICARE Program
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TRICARE Newsroom. TRICARE Coverage of Weight Loss Medications: What to Know
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Express Scripts. Changes to Your TRICARE Pharmacy Benefit
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Express Scripts. TRICARE Formulary – Wegovy Prior Authorization Criteria
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TRICARE Newsroom. Getting Prior Authorizations for TRICARE Prescriptions: Your Questions Answered
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TRICARE. Prior Authorization and Medical Necessity
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TRICARE. Appeals
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TRICARE Newsroom. Q&A: TRICARE For Life Coverage of Weight Loss Medications