Saxenda and Medicare coverage and cost
Saxenda (liraglutide) is a GLP-1 agonist injection pen medication. It helps with sustained weight loss for adults with obesity, adults with overweight who are experiencing weight-related health issues, and children under certain conditions.
Doctors typically prescribe Saxenda as part of an overall weight management strategy, which incorporates lifestyle changes such as nutrition changes and physical exercise.
Saxenda falls outside Medicare drug plan coverage because Medicare does not cover GLP-1 agonists when doctors prescribe them specifically for weight management.
While Medicare may cover other GLP-1 agonists for treating conditions such as diabetes, the Food and Drug Administration (FDA) has only approved Saxenda for weight loss purposes. This effectively eliminates any pathway to Medicare coverage for this particular medication.
Saxenda can be expensive without insurance, with a single injection package priced at approximately $1,400.
A person might be eligible for the manufacturer’s savings program, which lowers the cost to $25 per box.
Additionally, a person needs to consider that the manufacturer has reported limited availability of this medication due to high demand, which may occasionally make it challenging to fill a prescription.
That said, other resources that might help a person afford Saxenda include NeedyMeds and the Medicine Assistance Tool.
Medicare drug plans generally cover at least two drugs from the most commonly prescribed categories of medications. People with diabetes may qualify for an alternative GLP-1 agonist through Medicare if doctors prescribe the drug to manage their condition rather than for weight loss. Options include Mounjaro (tirzepatide) and Ozempic (semaglutide).
Additionally, a person with obesity who is at high risk for a heart attack or stroke may also qualify for Wegovy (semaglutide).
However, the specific GLP-1 drugs a person can get through Medicare, as well as the associated out-of-pocket costs, will depend on the specific Medicare Part D or Medicare Advantage prescription drug (MAPD) plan in which they are enrolled.
The United States government had once considered expanding Medicare and Medicaid coverage to include GLP-1 agonist drugs specifically for weight loss by 2026. However, the current administration has since dropped this plan.
Therefore, it is unclear when Medicare drug plans might begin to cover GLP-1 agonists for weight loss alone.