Want to add the VA angle for veterans not on Tricare:
The VA added semaglutide (Ozempic) to their national formulary in 2024 for T2D. For obesity specifically, it's available through the VA MOVE! Weight Management Program, but availability varies wildly by VAMC. My local VA in Phoenix has been prescribing it through MOVE! since mid-2025 — copay is $0 for service-connected conditions, $15 for non-service-connected if you're in Priority Group 1-6.
Tirzepatide (Mounjaro) is available at some VAMCs through individual VISN formulary decisions, but it's not national formulary yet.
If you're a veteran with service-connected obesity-related conditions (sleep apnea, diabetes, MSK injuries causing limited mobility), push for the service-connection angle. It opens doors.
OCONUS perspective — we're at Kadena (MariaRD). My husband is active duty AF and I'm the one who needed the GLP-1. Tricare overseas is administered by International SOS, and the formulary is technically the same as CONUS but getting anything through the overseas pharmacy is a nightmare.
What worked: my PCM at the 18th MDG prescribed Ozempic, and I got it filled at the base pharmacy after a 3-week wait for them to order it. $0 copay. But when they ran out (happened twice), I had to go 3 weeks without because there's no retail network pharmacy option here.
If you're OCONUS, build a buffer supply. Ask your doctor to prescribe a 90-day supply and fill as soon as eligible. Don't let yourself get down to the last pen.
UPDATE: Called Express Scripts Federal yesterday. My PCM submitted the PA for Ozempic 0.5mg with my prediabetes diagnosis (A1C 6.1), hypertension, and sleep apnea documentation.
PA was approved in 3 business days. Copay through Express Scripts mail-order: $14 for 90-day supply. That's less than $5/month for semaglutide.
I'm genuinely shocked at how straightforward this was once I knew the right approach. The key was asking for Ozempic (diabetes indication) instead of Wegovy (weight management indication). Same molecule, completely different coverage outcome.
Thank you to everyone, especially the military medical folks. Semper Fi (AussieAnna version — yes, we say it too, deal with it Marines).
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