The Department of Veterans Affairs covers GLP-1 receptor agonists — but the formulary status, prior authorization pathway, and covered indications differ sharply depending on whether the drug is prescribed for type 2 diabetes, chronic weight management, MASH, or cardiovascular risk reduction. Ozempic is on the VA national formulary with local PA criteria, while Wegovy is classified non-formulary and requires a non-formulary drug request. CHAMPVA — the Civilian Health and Medical Program of the Department of Veterans Affairs — follows a separate coverage framework that was updated in 2025 to restrict weight-loss GLP-1 coverage.
This guide maps VA GLP-1 coverage by drug and indication, details the non-formulary request process for Wegovy, explains CHAMPVA rules, and identifies what prescribers, benefit verification teams, and VA pharmacy staff should monitor. It is independent information and not medical advice or reimbursement guidance for a specific patient or plan.
Quick answer
| GLP-1 Drug | VA Formulary Status | VA Covered Indications | CHAMPVA Coverage |
|---|---|---|---|
| Ozempic (semaglutide injection) | Formulary — local PA required (Tier 2 copay) | T2D, CKD/cardiovascular risk reduction in T2D | T2D only |
| Mounjaro (tirzepatide injection) | Formulary — local PA required (Tier 2 copay) | T2D | T2D only |
| Wegovy (semaglutide injection) | Non-formulary — non-formulary request + PA required (Tier 3 copay) | Weight management (non-formulary criteria), MASH (2026 CFU), CVD risk reduction | MACE prevention only |
| Wegovy (semaglutide tablets, oral) | Non-formulary — non-formulary request required | Weight management (2026 criteria) | Not listed separately |
| Trulicity (dulaglutide) | Formulary — PA criteria | T2D | T2D only |
| Victoza (liraglutide injection) | Formulary — PA criteria | T2D | T2D only |
| Rybelsus (semaglutide tablets) | Non-formulary | T2D (non-formulary criteria) | T2D only |
| Saxenda (liraglutide 3 mg) | Non-formulary | Chronic weight management (non-formulary criteria) | Not covered |
| Zepbound (tirzepatide injection) | Non-formulary | Weight management (non-formulary criteria) | OSA only |
Who this is for
- Veterans navigating GLP-1 coverage through VA health care
- VA prescribers and clinical pharmacy specialists processing GLP-1 prior authorizations and non-formulary requests
- Benefit verification and prior authorization specialists handling VA pharmacy claims
- CHAMPVA beneficiaries and their providers
- Market access teams at GLP-1 manufacturers tracking government payer policy
- Veteran service organizations assisting beneficiaries with GLP-1 access
Source standard
Every fact in this guide is sourced from the VA Formulary Advisor (va.gov/formularyadvisor), VA Pharmacy Benefits Management Services criteria-for-use documents, VA Meds by Mail CHAMPVA coverage lists, the Journal of General Internal Medicine VA semaglutide study, and official VA publications dated 2024–2026. The VA formulary was last refreshed May 22, 2026. Always verify current formulary status and criteria for use through the VA Formulary Advisor or by contacting your local VA pharmacy.
VA formulary structure and GLP-1 classification
The VA operates a single national formulary managed by the VA Pharmacy Benefits Management Services (PBM) and the National Formulary Committee. Unlike commercial insurers that maintain separate formularies by plan, the VA has one overarching list with three relevant statuses for GLP-1 drugs:
- Formulary (PA-F) — On the national formulary with local prior authorization requirements managed at the VA facility level. This applies to Ozempic and Mounjaro.
- Non-formulary (NF) — Not on the national formulary. Requires a non-formulary drug request and prior approval before dispensing. Formulary alternatives must be considered first. This applies to Wegovy (all formulations), Saxenda, Zepbound, and Rybelsus.
- Not approved (NAP) — Not covered under the VA pharmacy benefit at all.
The VA Formulary Advisor lists the formulary data refresh date and links to the current criteria-for-use (CFU) documents for each drug.
Ozempic and Mounjaro: formulary GLP-1s for T2D
Ozempic (semaglutide injection for T2D) and Mounjaro (tirzepatide injection for T2D) are on the VA national formulary with local prior authorization managed at the facility level.
Ozempic (formulary, Tier 2)
- Formulary status: PA-F (local prior authorization required)
- Copay tier: Tier 2
- Effective date: May 25, 2023
- CFU document: Criteria for Use: Semaglutide (OZEMPIC) Injection for Type 2 Diabetes Mellitus [2026-04]
- Covered indications: T2D glycemic control; cardiovascular and kidney risk reduction in T2D per FDA labeling
The VA evaluates Ozempic PA requests based on documented T2D diagnosis, prior diabetes therapy use, and clinical appropriateness relative to formulary alternatives. Ozempic is the only semaglutide product on the VA national formulary.
Mounjaro (formulary, Tier 2)
- Formulary status: PA-F (local prior authorization required)
- Copay tier: Tier 2
- CFU document: Tirzepatide injection criteria for T2D
- Covered indications: T2D glycemic control
Wegovy: non-formulary with criteria for use
Wegovy (semaglutide injection for weight management) and Wegovy tablets (oral semaglutide for weight management) are both classified as non-formulary on the VA national formulary. This means:
- A non-formulary drug request must be submitted by the prescribing VA provider
- The provider must explain why formulary alternatives are not clinically appropriate
- Local VA Pharmacy and Therapeutics (P&T) committee policies govern adjudication
- Copay tier is Tier 3 (highest tier)
Wegovy injection for weight management
- Formulary status: NF (non-formulary)
- Copay tier: Tier 3
- Effective date: June 17, 2021 (injection)
- CFU documents:
- Criteria for Use: Semaglutide (WEGOVY) for weight management [2026-04]
- Clinical Recommendations: Semaglutide (WEGOVY) Subcutaneous Injection Conversion Guidance [2023-02]
- Weight Management Medications for Chronic Use — Clinical Recommendations for Treatment Selection [2026-03]
Wegovy for MASH
On January 1, 2026, the VA published a new criteria-for-use document for Wegovy in metabolic dysfunction-associated steatohepatitis (MASH), following the FDA approval of semaglutide for this indication:
- CFU document: Criteria for Use: Semaglutide (WEGOVY) in Metabolic Dysfunction-Associated Steatohepatitis (MASH) [2026-01]
- National Drug Monograph: Semaglutide (WEGOVY) in MASH [2026-01]
Exclusion criteria for the MASH CFU include:
- Child-Pugh score ≥ 7
- Decompensated liver cirrhosis
- FibroScan liver stiffness measurement greater than 18 kPa
Non-formulary request process
When a VA provider requests Wegovy (or another non-formulary GLP-1), the request is evaluated against published CFU criteria. The VA PBM guidance states that "in general, the VANF medications are to be considered prior to non-formulary agents." This means formulary weight-management medications — phentermine/topiramate, orlistat, and naltrexone/bupropion — are typically expected to be considered before non-formulary semaglutide or tirzepatide.
However, a VA medication use evaluation across 37 VA medical centers found that a high percentage of patients received semaglutide and tirzepatide as first-line therapy because they satisfied first-line criteria based on BMI or comorbidities.
VA MOVE! weight management program
The VA's MOVE! Weight Management Program is a behavioral lifestyle intervention that plays an important role in GLP-1 coverage decisions. VA data show that:
- 88% of patients prescribed weight-management GLP-1s had documented participation in MOVE! or another approved clinical lifestyle intervention (CLI)
- Patients who combined medication with MOVE! achieved higher rates of clinically significant weight loss (≥5% body weight) than those on medication alone (49% vs. 37%)
- Documentation of MOVE! participation may be required as part of the non-formulary request criteria for Wegovy
A study published in the Journal of General Internal Medicine tracking 201 veterans prescribed semaglutide at the Rocky Mountain Regional VA Medical Center in Aurora, Colorado, found that after one year, veterans averaged 10% body weight loss with measurable improvements in BMI, blood pressure, LDL cholesterol, triglycerides, and blood sugar.
VA cost-sharing for GLP-1 drugs
VA medication copays are determined by the veteran's priority group and the drug's copay tier:
| Copay Tier | Monthly Copay (per 30-day supply) | Notes |
|---|---|---|
| Tier 1 (preferred generics) | $5 | Preferred generic medications |
| Tier 2 (non-preferred generics/OTC) | $8 | Non-preferred generics, some OTC drugs |
| Tier 3 (brand-name) | $11 | Ozempic, Mounjaro, Wegovy, Saxenda, Zepbound |
- Priority Group 1 veterans: No copay for any medications
- Priority Groups 2–8: Copay applies per 30-day supply
- Annual copay cap: $700 (once reached, no additional copays for the rest of the year)
These copays are significantly lower than commercial or Medicare out-of-pocket costs for GLP-1 drugs.
CHAMPVA GLP-1 coverage
CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is a separate program that covers eligible dependents and survivors of veterans. CHAMPVA GLP-1 coverage rules were updated and are more restrictive than VA coverage.
CHAMPVA covered GLP-1 indications
As of the latest update, CHAMPVA covers prescription GLP-1 medications only for these FDA-approved reasons:
| GLP-1 Drug | CHAMPVA Covered Indication | Not Covered |
|---|---|---|
| Ozempic | Type 2 diabetes | Weight loss |
| Mounjaro | Type 2 diabetes | Weight loss |
| Trulicity | Type 2 diabetes | Weight loss |
| Victoza | Type 2 diabetes | Weight loss |
| Rybelsus | Type 2 diabetes | Weight loss |
| Wegovy | Prevention of major adverse cardiovascular events (MACE) | Weight loss alone |
| Zepbound | Obstructive sleep apnea (OSA) | Weight loss alone |
| Saxenda | Not covered | All indications |
Key CHAMPVA rules:
- Weight loss is not a covered indication for any GLP-1 drug under CHAMPVA
- Wegovy is covered only for MACE prevention, not chronic weight management
- Zepbound is covered only for moderate-to-severe obstructive sleep apnea, not weight management
- GLP-1 prescriptions for T2D must include the appropriate diagnosis code
- Medications are dispensed through the VA Meds by Mail program
What to monitor
- VA CFU updates: The VA PBM updates criteria-for-use documents regularly. The Wegovy weight-management CFU was updated in April 2026 and the MASH CFU was published January 2026. Check the VA Formulary Advisor for the most current versions.
- Formulary status changes: Wegovy's non-formulary status could change if the VA National Formulary Committee determines that formulary access is warranted based on updated clinical evidence or cost negotiations.
- New FDA approvals: GLP-1 drugs receiving new FDA indications (e.g., MASH, sleep apnea, kidney disease) will trigger new CFU documents. Providers should monitor FDA approvals and VA PBM guidance.
- CHAMPVA formulary updates: The CHAMPVA covered medication list is updated periodically. The MACE and OSA coverage pathways for Wegovy and Zepbound are recent additions.
- Foundayo (orforglipron): FDA-approved April 1, 2026 for weight loss, this oral non-peptide GLP-1 could be added to the VA formulary or non-formulary list. Monitor VA Formulary Advisor for new entries.
- IRA price negotiation: Wegovy and Ozempic are selected for Medicare IRA price negotiation effective January 2027. While this does not directly affect VA pricing (VA has its own Federal Supply Schedule pricing), it could influence broader formulary decisions.
Disclaimer
This article is independent information for health care professionals and is not medical advice, reimbursement guidance, or legal counsel for any specific patient, provider, or VA facility. VA formulary status and criteria for use change over time. Always verify current coverage through the VA Formulary Advisor (va.gov/formularyadvisor), your local VA pharmacy, or the VA Meds by Mail program for CHAMPVA.
Sources
- VA Formulary Advisor: Semaglutide injection (Ozempic) — formulary status PA-F, Tier 2, CFU updated 2026-04. https://www.va.gov/formularyadvisor/drugs/4040140-SEMAGLUTIDE-INJ-SOLN
- VA Formulary Advisor: Semaglutide injection (Wegovy) — formulary status NF, Tier 3, CFU updated 2026-04. https://www.va.gov/formularyadvisor/drugs/4040576-SEMAGLUTIDE-INJ-SOLN
- VA Formulary Advisor: Semaglutide tablets (Wegovy oral) — formulary status NF, Tier 3. va.gov/formularyadvisor
- VA Formulary Advisor: Tirzepatide injection (Mounjaro) — formulary status PA-F, Tier 2. va.gov/formularyadvisor
- VA Pharmacy Benefits Management Services: Criteria for Use: Semaglutide (WEGOVY) in MASH, January 2026. va.gov/formularyadvisor
- VA PBM: Weight Management Medications for Chronic Use — Clinical Recommendations for Treatment Selection, March 2026. va.gov/formularyadvisor
- U.S. Medicine: "Determining What Weight Loss Medications Are Best for Veterans," 2025 Compendium of Federal Medicine. usmedicine.com
- Military.com: "A VA Clinic Gave Veterans GLP-1s for Weight Loss. A Year Later, Everything Improved." Brandon Wile, 2026. military.com
- Journal of General Internal Medicine: VA semaglutide weight management study, Rocky Mountain Regional VA Medical Center.
- VA.gov: CHAMPVA prescription medications covered through Meds by Mail — GLP-1 coverage changes. va.gov/resources/prescription-medications-covered-through-meds-by-mail
- SingleCare: "Does the VA Cover Wegovy?" — VA national formulary and non-formulary request process. singlecare.com
- KFF: "Medicaid Coverage of and Spending on GLP-1s," updated 2026. kff.org
- FDA.gov: Wegovy (semaglutide) prescribing information, FDA-approved indications for chronic weight management, CVD risk reduction, and MASH. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/215256s012s013lbl.pdf
