The VA does cover Ozempic, but its criteria are written for type 2 diabetes. The VA Formulary Advisor lists Ozempic as PA-F, meaning it is on the VA National Formulary and may have prior authorization requirements managed at the local facility level[1]. Its criteria for use start with one inclusion: a diagnosis of type 2 diabetes[8].
For weight loss, the semaglutide brand is Wegovy, and the tirzepatide brand is Zepbound. The VA covers both only by request. Each is listed NF, not on the VA national formulary, and requires a non-formulary drug request and prior approval to be dispensed[2][3]. What the same drugs cost outside the VA is in GLP-1 cost without insurance.
| Drug | Status | What it means |
|---|---|---|
| Ozempic (semaglutide) | PA-F | On the formulary; local prior authorization may apply |
| Mounjaro (tirzepatide) | PA-F | On the formulary; local prior authorization may apply |
| Wegovy (semaglutide) | NF | Not on the formulary; needs a non-formulary request and prior approval |
| Zepbound (tirzepatide) | NF | Not on the formulary; needs a non-formulary request and prior approval |
Ozempic for diabetes: the VA’s criteria
The Ozempic criteria for use, revised April 2026, require a diagnosis of type 2 diabetes and then one of three further conditions[8]. The first is established atherosclerotic cardiovascular disease or chronic kidney disease in a patient who is not a good candidate for empagliflozin[8]. The second is glucose goals not met on empagliflozin plus maximally tolerated metformin, unless the patient cannot use them[8].
The third lets a prescriber replace insulin, a sulfonylurea, a DPP-4 inhibitor or a TZD, irrespective of A1c, with intent to reduce weight, hypoglycemic risk or improve outcomes[8]. The document also lists exclusions, including a personal or family history of medullary thyroid carcinoma, a history of pancreatitis with a cause that still presents a risk, and pregnancy[8].
Mounjaro, the diabetes brand of tirzepatide, carries the same PA-F status on the formulary[4]. The Formulary Advisor links it to its own criteria for type 2 diabetes[4]. The Ozempic criteria are not a route to a weight-loss prescription without diabetes: their first inclusion is the diagnosis[8].
Wegovy and Zepbound for weight: what the criteria require
The VA Pharmacy Benefits Management criteria for Wegovy and for Zepbound, both revised April 2026, set the same two inclusion criteria[6][7]. The first is documented participation in a comprehensive lifestyle intervention that targets diet, physical activity and behavioral change[6]. The second is a BMI of 27 or more with at least one weight-related condition[6].
The criteria give examples of those conditions: hypertension, type 2 diabetes, prediabetes, dyslipidemia, metabolic syndrome, obstructive sleep apnea and osteoarthritis[6]. The list continues with metabolic dysfunction-associated steatotic liver disease and heart failure with preserved ejection fraction[6]. The Zepbound criteria add previous heart attack, previous stroke and symptomatic peripheral arterial disease to the list[7].
On the lifestyle requirement, veterans with documented participation within the past year, on at least one occasion, are eligible for consideration[6]. The VA’s MOVE! program is one example, and other programs can count if they meet the VA’s definition[6]. The June 2026 treatment guidance says self-management tools used without clinician contact do not meet that definition[9].
Both documents list exclusions: known pregnancy, lactation, type 1 diabetes, and a personal or family history of medullary thyroid carcinoma or MEN 2[6][7]. They also exclude severe gastrointestinal dysmotility and a history of pancreatitis with a cause that still presents a risk[6][7]. Each says individual cases that are exceptions should be decided at the local facility by its pharmacy and therapeutics committee[6].
What a VA fill costs
In priority group 1 you pay no copay for any medication[10]. In priority groups 2 through 8 you may pay a copay for medications that treat a non-service-connected condition, set by the drug’s tier and the days of supply[10]. Once $700 in medication copays has been charged in a calendar year, you pay no more that year[10].
| Tier | 1 to 30 days | 31 to 60 days | 61 to 90 days |
|---|---|---|---|
| Tier 2 (Ozempic) | $8 | $16 | $24 |
| Tier 3 (Mounjaro, Wegovy, Zepbound) | $11 | $22 | $33 |
The tier comes from the Formulary Advisor: Ozempic is tier 2, and Mounjaro, Wegovy and Zepbound are tier 3[1][4][2][3]. VA.gov describes tier 3 as brand-name prescription medicines[10].
A private prescription does not transfer
VA pays a community pharmacy for urgent care prescriptions, up to a 14-day supply, when the drug is on its Urgent/Emergent Formulary[11]. A non-urgent prescription you take regularly, or one for more than a 14-day supply, must be filled through VA[11]. The Formulary Advisor shows Wegovy with an Urgent/Emergent Formulary flag of N[2]. A weekly GLP-1 is a regular prescription, so the route to VA coverage runs through a VA prescriber and the criteria above.
Compounded semaglutide and the VA
The VA’s criteria name branded products. The Formulary Advisor’s glossary defines a Non-Approved Product as one not covered under the VA Pharmacy Benefit because it is not on the VA National Formulary and has not been approved by FDA[5]. FDA states that compounded drugs are not FDA approved[12]. Veterans who pay out of pocket for compounded semaglutide or tirzepatide can compare monthly prices on the price boards.
The question to ask your VA prescriber
Ask whether your record shows lifestyle-program participation in the past year, and which weight-related condition it documents. Those two entries decide whether a non-formulary request for Wegovy or Zepbound meets the criteria. TRICARE rules differ and are set out in does TRICARE cover Wegovy. Medicare coverage is in does Medicare cover Ozempic, and whether a maker’s savings card works alongside government coverage is in Wegovy savings card.