The Short Answer: Yes, GLP-1s Are HSA/FSA Eligible
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use those pre-tax dollars to pay for GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound—as well as compounded semaglutide and tirzepatide.
The IRS considers prescription medications a qualified medical expense. Since all GLP-1s require a prescription, they automatically qualify. This is true whether you're using them for diabetes, weight loss, or other FDA-approved indications.
How Much You'll Actually Save
HSA and FSA contributions are made pre-tax, meaning you avoid paying income tax on that money. Your savings depend on your marginal tax rate:
💵 Your HSA/FSA Savings by Tax Bracket
Example: If you're in the 32% tax bracket and spend $350/month on Wegovy through NovoCare ($4,200/year), using HSA funds saves you $1,344 per year in taxes you would have paid on that income.
HSA vs. FSA: Key Differences
| Feature | HSA | FSA |
|---|---|---|
| Eligibility | Must have HDHP insurance | Any employer-sponsored plan |
| 2026 Contribution Limit | $4,300 (individual) / $8,550 (family) | $3,300 |
| Rollover | Unlimited rollover | Use it or lose it (with exceptions) |
| Portability | Yours forever | Tied to employer |
| Investment Option | Yes, can invest | No |
Do You Need a Letter of Medical Necessity?
It depends on how your GLP-1 is prescribed:
| Prescription Type | LMN Required? | Notes |
|---|---|---|
| Ozempic/Mounjaro for Diabetes | No | Diabetes is a clear medical indication |
| Wegovy/Zepbound for Obesity (BMI ≥30) | Maybe | Some administrators require it |
| Compounded GLP-1s | Likely Yes | Documentation strengthens your case |
| "Off-label" weight loss (BMI <30) | Yes | Need documented medical necessity |
What Should an LMN Include?
A proper Letter of Medical Necessity should contain:
- Your name and date of birth
- Diagnosis code (E66.9 for obesity, E11 for type 2 diabetes)
- Your BMI and relevant health metrics
- Statement that the medication is medically necessary
- Provider's signature, credentials, and contact info
- Date of the letter
Which Telehealth Providers Accept HSA/FSA?
Most major telehealth providers accept HSA and FSA cards as payment. Here's a quick reference:
| Provider | HSA/FSA Accepted? | Notes |
|---|---|---|
| Hims/Hers | ✓ Yes | Automatic HSA/FSA card acceptance |
| Ro Body | ✓ Yes | Explicitly promotes HSA/FSA |
| Eden | ✓ Yes | Standard card acceptance |
| Calibrate | ✓ Yes | Can also use for program fees |
| NovoCare/LillyDirect | ✓ Yes | Brand manufacturer programs |
How to Pay with HSA/FSA
-
Check your balance
Log into your HSA/FSA portal to confirm available funds -
Get your prescription
Complete a telehealth consultation or see your doctor -
Pay with your HSA/FSA card
Use your benefits debit card at checkout like any credit card -
Save your documentation
Keep receipts and LMN in case of audit
FSA Deadline Alert: Use It or Lose It
Unlike HSAs, most FSA funds expire at the end of the plan year. However, your employer may offer one of these options:
| Option | How It Works | Deadline |
|---|---|---|
| Grace Period | Extra 2.5 months to use funds | Typically March 15 |
| Rollover | Carry over up to $640 to next year | No deadline |
| Neither | Funds expire Dec 31 | December 31 |
Common Mistakes to Avoid
1. Assuming weight loss = not eligible. Weight loss medications ARE eligible when prescribed for a diagnosed medical condition (obesity is a disease with ICD-10 code E66).
2. Not keeping receipts. If your HSA/FSA is audited, you'll need to prove the expense was for a qualified medical purpose. Save everything.
3. Missing the LMN requirement. Some stricter FSA administrators require documentation. Better to have it and not need it.
4. Forgetting consultation fees. The telehealth consultation fee is ALSO HSA/FSA eligible—not just the medication itself.
5. Letting FSA funds expire. Don't donate money back to your employer. Stock up on eligible expenses before your deadline.
Can You Use HSA/FSA for Compounded GLP-1s?
Yes. Compounded medications are HSA/FSA eligible as long as they're prescribed by a licensed healthcare provider. The key requirements:
- Valid prescription from a licensed provider
- Medication dispensed by a licensed pharmacy
- Treatment for a diagnosed medical condition
- Documentation (LMN recommended)
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