Veteran says Tricare denied weight-loss drugs

A veteran’s post on X on May 23 said Tricare For Life had refused to cover weight-loss drugs and argued the policy leaves older beneficiaries exposed to obesity-related illnesses. The post, published from the account Budreaux6, said the denial affects patients over 65 and linked the coverage decision to risks including heart disease, cancer, diabetes, sleep apnea and stroke. The complaint points to a policy the Defense Health Agency put in place in 2025 for Tricare For Life, the Medicare-wraparound program for military retirees and family members. Tricare’s public guidance says those beneficiaries are no longer covered for drugs prescribed for weight loss. ### When did Tricare For Life stop covering these drugs? Aug. 31, 2025 is the date Tricare says it began implementing revised prior-authorization criteria for weight-loss drugs. Tricare’s coverage page says the program no longer covers weight-loss drugs for Tricare For Life beneficiaries, as well as some other groups, and that affected patients would have to pay the full cost if they obtained the drugs elsewhere. Sept. 8, 2025 is the date the Defense Health Agency published a Q&A explaining the change. The agency said Express Scripts, the Tricare Pharmacy Program contractor, mailed notification letters to affected beneficiaries on July 31, 2025, 30 days before the policy took effect. ### What does the government say the rule is? (tricare.mil) The Defense Health Agency said Tricare For Life coverage of those drugs “isn’t authorized when obesity is the sole or major condition treated.” In the same Q&A, the agency said federal law does not authorize Tricare For Life to cover weight-loss medications when prescribed for weight loss as the sole or major condition, “regardless of the patient’s age.” (newsroom.tricare.mil) Tricare’s coverage page says the change is “consistent with existing statutory and regulatory authority” and was made to ensure prescription processing meets federal coverage requirements. The page also says, “In general, TRICARE doesn’t cover weight loss products.” ### Why do some retirees say Medicare can cover similar drugs? Medicare Part D operates under different rules from Tricare For Life, according to both CMS and the Defense Health Agency. (newsroom.tricare.mil) CMS said in its Contract Year 2026 policy fact sheet that anti-obesity medications are coverable under Part D only when used for another medically accepted indication, such as type 2 diabetes or reducing the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight. (tricare.mil) The Defense Health Agency said Medicare Part D may cover certain weight-loss medications for non-obesity conditions, including sleep apnea or reducing cardiovascular risk, but that Tricare For Life follows separate federal laws and regulations. Those laws and regulations, the agency said, exclude medications intended to control or reduce weight, regardless of co-morbid conditions. (cms.gov) ### Which Tricare beneficiaries can still get weight-loss drugs covered? Tricare says beneficiaries enrolled in Tricare Prime plans, Tricare Select plans and certain premium-based plans may still receive coverage for weight-loss drugs if a network provider prescribes them, the drugs are medically necessary, and prior-authorization requirements are met. The same page lists Wegovy, Zepbound, Saxenda, Qsymia, Phentermine and Contrave among the weight-loss medications subject to those rules. (newsroom.tricare.mil) The Tricare page also says diabetes drugs including Ozempic, Mounjaro, Trulicity and Victoza remain covered for all patients when medically necessary to treat diabetes. ### What can affected retirees check next? Tricare directs beneficiaries to its formulary search tool and prior-authorization materials to confirm whether a specific drug is covered. (tricare.mil) The Defense Health Agency also said patients affected by the Tricare For Life change should talk with their provider about what is appropriate during the transition and about other treatment options. (newsroom.tricare.mil)