Zepbound can be tax deductible. The limits are tight. The IRS counts prescribed medicines as medical expenses[1]. Weight-loss costs count only when they treat a disease a physician diagnosed[1]. The IRS names obesity, hypertension and heart disease[1]. Then comes the floor. You can deduct only the part of your medical expenses above 7.5% of your adjusted gross income[1].
None of the IRS documents cited here names Zepbound, Wegovy or any GLP-1. They set general rules. The rest of this page applies them, one line of the bill at a time. What a month of Zepbound costs is in Zepbound price.
Test one: the drug is prescribed
A prescribed drug, in the IRS’s words, is one that “requires a prescription by a doctor for its use by an individual”[1]. Apart from insulin, a drug that is not prescribed is not a medical expense[1]. Zepbound and Wegovy are prescription drugs, so they clear this test when you fill them on a prescription.
Compounded semaglutide and compounded tirzepatide are dispensed by a pharmacy on a prescription. The IRS text asks whether the drug is prescribed. It says nothing about compounding either way.
Test two: it treats a diagnosed disease
A prescription alone is not enough. Medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness[1]. They do not include costs that are merely beneficial to general health[1].
For weight loss the IRS is specific. Costs to lose weight count only if the weight loss treats a specific disease a physician diagnosed[1]. The IRS gives obesity, hypertension and heart disease as examples[1]. Its wellness FAQ applies the same test to weight-loss programs, naming obesity, diabetes, hypertension and heart disease[2].
Obesity itself qualifies. Rev. Rul. 2002-19 states that obesity “is medically accepted to be a disease in its own right”[4]. In that ruling, a taxpayer diagnosed with obesity could deduct a weight-loss program as treatment for it[4]. So could a second taxpayer without obesity, whose program treated diagnosed hypertension[4].
| Cost | What the IRS text says | Where it sits |
|---|---|---|
| Prescribed drug to treat diagnosed obesity or another disease | Prescribed medicines are includible; obesity is a disease | Counts toward the total |
| Same drug taken for appearance or general health | Weight-loss costs for appearance or well-being are excluded | Does not count |
| Amount an insurer or other source paid back | Reduce your total by all reimbursements | Does not count |
| Amount paid from an HSA, or fully reimbursed by an FSA | Cannot also be included as a medical expense | Does not count |
| Drug imported without FDA approval | Listed among expenses you cannot deduct | Does not count |
The 7.5% floor, in one line
The deduction is the year’s unreimbursed medical expenses minus 7.5% of AGI[1][3]. The floor applies to your total, not to each drug. At an AGI of $80,000, the floor is $6,000. The first $6,000 of the year’s medical costs deducts nothing.
| Unreimbursed medical expenses for the year | Floor (7.5% of AGI) | Amount above the floor |
|---|---|---|
| $6,000 | $6,000 | $0 |
| $9,000 | $6,000 | $3,000 |
| $12,000 | $6,000 | $6,000 |
Every qualifying cost counts: other prescriptions, doctor visits, lab work, and premiums paid with after-tax money[1][3]. A GLP-1 alone may fall short of the floor. Stacked with the rest of a year’s care, it may not.
Itemizing comes before the floor
The medical deduction lives on Schedule A, which is for itemized deductions[3]. The instructions compare two totals: your itemized deductions and your standard deduction[3]. Taking the larger one usually means less federal income tax[3]. If the standard deduction is larger, the amount above the floor does not change your tax.
So the full test runs in order. The drug is prescribed. It treats a diagnosed disease. The year’s total clears 7.5% of AGI. Your itemized deductions beat the standard deduction.
What you cannot count twice
You must reduce your medical expenses by every reimbursement from insurance or other sources during the year[1]. You can include only the expenses you paid this year[1].
Tax-favored accounts are the common trap. You cannot include expenses paid with a tax-free HSA distribution[1]. You cannot include amounts fully reimbursed by an FSA funded with pre-tax pay[1]. The IRS FAQ says it plainly. An amount paid or reimbursed by an HSA, FSA, Archer MSA or HRA cannot also be deducted[2]. Which account can pay for a GLP-1 is covered in can you use an HSA for peptides.
Timing: the year of the charge
The date you pay decides the year. For a check, it is generally the day you mail or deliver it[1]. For a credit card, it is the year of the charge, not of the card payment[1]. You generally cannot include payments for care you will receive in a future year[1]. A December prepay for next year’s supply may not count this year.
Imported and unapproved drugs
Generally you cannot include a prescribed drug brought in or shipped from another country[1]. The exception is a drug imported legally, such as one FDA announces individuals may import[1]. The Schedule A instructions list “Imported drugs not approved by the U.S. Food and Drug Administration” among expenses you cannot deduct[3]. That includes foreign-made versions of U.S.-approved drugs made without FDA approval[3].
The records that carry the claim
Keep three things together for each fill. The prescription. The diagnosis it treats. The receipt showing what you paid and when. If a bill bundles the drug with a membership or shipping, ask for an itemized receipt. Sales tax on the order is a separate question, covered in sales tax on compounded semaglutide. The full monthly cost of each GLP-1 route is in GLP-1 cost without insurance.