It's the first question most people ask after learning about GLP-1 medications like Ozempic and Mounjaro: "Will my medical aid pay for it?"
The short answer is: it depends — on your scheme, your plan, your diagnosis, and whether your doctor can meet specific clinical criteria. Here's a full breakdown of how medical aid coverage actually works for GLP-1 medications in South Africa, and what your options are if you're paying out of pocket.
The Current State of Medical Aid Coverage
Medical schemes in South Africa are required by law to cover the treatment of type 2 diabetes as a prescribed minimum benefit (PMB). However, they are not required to cover the cost of GLP-1 medications specifically — and many provide only limited or conditional coverage even for diabetes use.
For weight management, the picture is even more restrictive. Obesity is not currently classified as a PMB in South Africa, which means schemes have no legal obligation to fund weight loss treatment from chronic medication benefits.
This creates an awkward gap: GLP-1 medications are clinically proven to treat obesity effectively, and the South African Metabolic Medicine and Surgery Society (SAMMSS) published guidelines in November 2025 recommending their use for obesity treatment — yet the funding framework hasn't caught up.
How Discovery Health Handles GLP-1 Coverage
Discovery Health Medical Scheme, the country's largest, covers GLP-1 agonists for type 2 diabetes under certain conditions. For members registered for type 2 diabetes on most plan types (excluding the KeyCare Series), GLP-1 medications are funded from the Chronic Illness Benefit — but only when specific clinical criteria are met.
If those criteria aren't met, the medication is funded from the member's day-to-day benefits: the medical savings account and above-threshold benefit. For weight management, Discovery has stated that only Saxenda (liraglutide) — registered specifically for obesity — is funded, and only from day-to-day benefits subject to plan rules.
In practice, this means most Discovery members using Ozempic or Mounjaro for weight loss are paying largely out of pocket, with some contribution from their savings account.
How Momentum Health Solutions Responds
Momentum has acknowledged the significant increase in claims and prescriptions for GLP-1 medications, as well as a rise in off-label use for weight management. However, their stated position focuses on ensuring these medications remain available for their approved indications — primarily diabetes.
Momentum has implemented tighter funding policies, therapeutic substitution requirements, and reference pricing co-payments to manage costs and demand. They have also emphasised the importance of comprehensive medical evaluation to identify underlying conditions like hypothyroidism, PCOS, and psychological factors before prescribing weight loss medications.
What You'll Typically Pay Out of Pocket
If you're using a GLP-1 for weight management without medical aid coverage, here's what to expect at maintenance doses:
Ozempic (semaglutide): R1,700–R3,200 per month at standard doses, rising to R6,000+ at 2mg weekly.
Wegovy (semaglutide): R3,000–R6,000 per month depending on dose.
Mounjaro (tirzepatide): R3,000–R6,000 per month depending on dose.
Saxenda (liraglutide): R4,500–R5,000 per month at maintenance dose.
These costs can vary between pharmacies. The government sets a Single Exit Price for all medications, but final retail costs differ based on dispensing fees and pharmacy markups.
Tips for Maximising Your Medical Aid Benefits
If you have medical aid and want to explore GLP-1 coverage, here are practical steps:
Get your doctor to submit a proper motivation. For diabetes patients, GLP-1 coverage typically requires documented evidence that first-line treatments (like metformin) haven't achieved adequate control. Your doctor needs to submit pathology results and a clinical motivation to the scheme.
Understand your plan's benefit structure. Know the difference between your chronic illness benefit, medical savings account, and above-threshold benefit. Even if GLP-1s aren't covered under chronic benefits, your savings account may contribute.
Ask about therapeutic alternatives. Some schemes have preferred products or formulary restrictions. Your doctor may need to prescribe a specific GLP-1 that your scheme covers, rather than your first choice.
Check whether your scheme covers Mounjaro for weight management. Since Mounjaro received SAHPRA approval for weight management in October 2025, some schemes may begin offering coverage — though this varies and is worth confirming directly.
Keep records of all out-of-pocket spending. GLP-1 medication costs may qualify as medical expenses for tax purposes. Consult a tax professional about claiming these through your medical tax credit.
Will Coverage Improve?
There are reasons to be cautiously optimistic. Several developments suggest that medical aid coverage for GLP-1 medications could expand:
The World Health Organisation is considering adding GLP-1 agonists to its Essential Medicines List, which would put pressure on national health systems to broaden access. SAMMSS guidelines now formally recommend GLP-1s for obesity treatment. And generic semaglutide is expected to enter the global market as key patents expire, with Aspen Pharmacare among companies planning to manufacture and distribute generic versions — potentially reaching South Africa by 2027.
Lower prices from generic competition would significantly change the cost-benefit calculation for medical schemes. Until then, the reality is that most South Africans using GLP-1 medications for weight management are funding treatment themselves.
The Value of Structured Medical Support
Whether your medical aid covers the medication or not, one thing remains constant: GLP-1 treatment works best with proper medical supervision. A doctor who monitors your progress, adjusts your dosing, and ensures you're responding safely will help you get the most value from every rand you spend — and reduce the risk of complications that could cost far more in the long run.
Telehealth services have made this kind of structured support more affordable and accessible, offering doctor consultations, prescription management, and pharmacy delivery without the overhead costs of traditional specialist visits.