FALLS CHURCH, Va. –
The Defense Health Agency recently announced it will implement existing regulatory controls regarding
TRICARE coverage of weight loss medications, including Glucagon-Like Peptide 1 (GLP-1) drugs, to ensure prescription processing aligns with federal coverage requirements. You may have questions, such as:
- Why do some plans cover these drugs while TRICARE For Life doesn’t?
- Should I stop taking my medication if TFL doesn’t cover it?
- Can I keep taking my prescription if I pay for it out of pocket?
“Many TFL beneficiaries have concerns about why some
obesity treatments are covered and others aren’t,” said Edward C. Norton, Chief, 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. Our goal is to help you understand the existing rules and how to explore options that still meet your needs.”
TFL offers Medicare wraparound coverage. It’s different from other TRICARE plan options, like TRICARE Prime or TRICARE Select.
Different laws govern TRICARE Prime and TRICARE Select. These laws allow the Department of Defense to offer certain additional preventive care services and health benefits when received from network providers under those plan options.
Q: Why does weight loss drug coverage differ between TFL and TRICARE Prime or TRICARE Select?
A: Federal law and regulation determine the differences.
Federal law doesn’t TFL to cover weight loss medications when prescribed for weight loss as the sole or major condition. This is true regardless of the patient's age.
Other than bariatric surgery, which is authorized for the treatment of morbid obesity, federal regulation only extends coverage for treatment of obesity for beneficiaries with TRICARE Prime or TRICARE Select benefits when provided by network providers.
Q: Why doesn't TFL follow Medicare's exceptions for sleep apnea and heart disease conditions?
A: TRICARE and Medicare operate under different legal frameworks with different coverage authorities.
Medicare Part D may cover certain weight loss medications for non-obesity conditions. These may include sleep apnea or reducing cardiovascular risk.
TFL follows separate federal laws and regulations. These laws and regulations exclude medications intended to control or reduce weight. This is regardless of the existence of co-morbid conditions.
Q: Why does this feel sudden?
A: We understand this may feel abrupt.
Express Scripts, the TRICARE Pharmacy Program contractor, mailed detailed notification letters to affected beneficiaries. These letters were mailed July 31, 2025 (30 days prior to the change).
If you are affected, you shouldn’t stop taking your medication right away. Ask your provider what’s most appropriate during this transition period.
Q: Which prior authorizations became invalid on Aug. 31?
A: Prior authorizations for obesity medications became invalid on Aug. 31 only for:
- Those with TFL
- Others not enrolled in TRICARE Prime, TRICARE Select, or premium-based plans (such as direct care only beneficiaries, foreign force members, or those with TRICARE Plus)
Q: I’m a TFL beneficiary. What happens if I try to fill my prescription after Aug. 31?
A: TRICARE will not cover your prescription. You can talk to your provider about other treatment options. Or you can prepare to pay for your prescription out of pocket.
Q: I have TFL and diabetes. Are my GLP-1 drugs still covered?
A: It depends. TRICARE covers certain GLP-1s for the treatment of type 2 diabetes. These include:
- Ozempic
- Trulicity
- Mounjaro
- Victoza
Coverage continues for all patients with a diagnosis of diabetes when prior authorization criteria are met. This is true regardless of their health plan.
Bottom line
We know this may be difficult. We encourage you to work closely with your provider. They can help you find safe and effective approaches that support your long-term health and well-being.
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