Is Ozempic Covered by Insurance?
Ozempic is an injectable medication that is prescribed to adults with type 2 diabetes. The generic name for Ozempic is semaglutide. Semaglutide works by mimicking a specific hormone (GLP-1) that is released in your gut after eating. This hormone helps your body produce more insulin, which lowers your blood sugar.
Ozempic can also help people lose weight. This is because the naturally occurring hormone, GLP-1, can slow down digestion and make you feel fuller. This can cause you to eat less and ultimately lead to weight loss. Wegovy is another brand name for semaglutide that is specifically prescribed for weight loss.
If you are considering taking Ozempic, you may be wondering if it’s covered by insurance.
When Ozempic is prescribed specifically for type 2 diabetes, most insurance plans cover Ozempic. However, it is typically not covered for weight loss. In that case, you may need to investigate other weight loss drugs such as Wegovy or Saxenda.
This guide goes over when insurance covers Ozempic, the cost of it, and alternatives if your insurance does not provide coverage.
When Ozempic is covered by insurance
If Ozempic is prescribed for managing type 2 diabetes, most private insurance plans will provide coverage. This is because this drug is FDA-approved specifically for the purpose of managing this medical condition. In some cases, Ozempic may be covered for pre-diabetes as well.
In most cases, Ozempic is also covered by Medicare, which provides coverage for people at least 65 years of age, who have disabilities, or who have end-stage renal disease. Several medications to treat diabetes, including Ozempic, are covered under Medicare Part D.
If you are eligible for Medicaid, you also may receive coverage. Like most plans, Medicaid only covers Ozempic for patients with type 2 diabetes. Whether or not Ozempic is covered by Medicaid will vary from state to state.
No matter what type of plan you have, you will need a prescription from your doctor specifically for type 2 diabetes to ensure Ozempic is covered by insurance. Even with coverage, you may still have some out-of-pocket expenses such as copays, deductibles, and coinsurance. This all depends on your specific insurance plan.
Cost of Ozempic with insurance
The cost of Ozempic depends on your insurance provider, the state you live in, and any copayments, deductibles, or coinsurance you may have. Any amount that you owe before your insurance provides coverage will depend on your specific plan.
You may qualify for assistance with your copayment through Novo Nordisk, the manufacturer of Ozempic. With an Ozempic savings card, you may save up to $150 for a one-month prescription, $300 for a two-month prescription, and up to $450 for a three-month prescription.
With this offer, you may even pay as little as $25 for a three-month supply of Ozempic. However, not everyone is eligible for this offer, and there are limitations. It is valid for up to 24 months and only for those who have commercial prescription insurance.
Find the right dietitian for you
When Ozempic is not covered by insurance
When Ozempic is used for weight loss, it is considered “off-label,” which means it is being used in a way that was not approved by the FDA. It is very difficult to get a health insurance company to cover off-label prescription medications.
Because Ozempic is an FDA-approved drug for treating type 2 diabetes only, most commercial insurance providers will not cover Ozempic if it is prescribed specifically for weight loss. Without prior authorization, which means your health insurance reviews and approves your medication in advance, you may not receive coverage for Ozempic.
Like commercial insurance providers, Medicare does not cover any medications for weight loss. In addition, very few states cover weight loss medications through Medicaid. If you are prescribed Ozempic and you do not have type 2 diabetes, you may be denied coverage.
Cost of Ozempic without insurance
The cost of Ozempic without insurance is around $935 for a one-month supply. What you end up paying may be affected by the dose you are prescribed, your pharmacy, and whether or not you are eligible for patient assistance programs.
If you have no insurance, Novo Nordisk offers a Patient Assistant Program, where Ozempic is provided at no cost to those who qualify. To be eligible, your total household income must be at or below 400% of the federal poverty level. You also cannot be enrolled in any other federal, state, or government program such as Veteran Affairs Benefits or Medicaid.
Alternatives if your insurance doesn’t cover Ozempic
As mentioned above, insurance companies will most likely not cover Ozempic if it is prescribed for a purpose other than diabetes. It can be difficult to get insurance to cover this drug if it is used for weight loss. If your insurance does not cover Ozempic, other similar medications may be a better option for you financially.
- Wegovy. Like Ozempic, Wegovy is an injectable medication used specifically for weight loss. It is not typically covered by health insurance, however, there are still some ways to receive coverage. If your employer-covered insurance does not cover medication to treat obesity, you may submit a request for coverage to increase your chances of gaining coverage. You can learn about the cost of Wegovy with and without insurance here, how long it takes to lose weight on Wegovy here, and ideal Wegovy diet plan here.
- Mounjaro. Mounjaro is a relatively new brand-name medication that is used to help manage type 2 diabetes. It may also trigger weight loss. Some insurance plans cover Mounjara, however, coverage varies from plan to plan. You can learn about the best diet while taking Mounjaro here.
- Rybelsus. Rybelsus is a semaglutide tablet prescribed to improve blood sugar. Most Medicare prescription drug plans and other insurance plans have this drug on their formulary. If you are eligible, you may receive a Rybelsus savings offer to pay as little as $10 for one month. You can learn about the best foods to eat on Rybelsus and which to avoid here.
- Trulicity. Trulicity is used along with diet and exercise by adults with type 2 diabetes to improve glycemic control. It is not a weight loss drug, but it may lead to weight loss for some people. Most Medicare prescription drug plans and insurance plans cover Trulicity. While you may still have a copay or other out-of-pocket expenses, you will most likely receive some sort of coverage. Note that there are important foods to avoid while taking Trulicity.
- Saxenda. Saxenda is an injectable prescription medication for adults who are overweight and have weight-related health issues. Insurance may or may not cover Saxenda, however, there are other ways to gain coverage. You may be able to receive coverage through your employer, if you have Medicaid, or if you are a government employee. You can learn more about the best diet while taking Saxenda here.
Reviewing Ozempic coverage for major types of health insurance plans
Whether or not you receive coverage for Ozempic will depend on your health insurance plan and your medical condition. While most major health insurance plans cover Ozempic for diabetes, the out-of-pocket expenses may vary.
Private or employer-sponsored health insurance plans
Private insurance plans usually have diabetes medications, such as Ozempic, on their formulary. If you have private insurance, you also may qualify for the Ozempic savings card to lower your costs even more.
Medications for weight loss are typically not covered by employer-sponsored health insurance plans. However, employers may cover Ozempic for type 2 diabetes. As with any insurance plan, coverage and out-of-pocket expenses will vary from plan to plan.
Medicare
Most Medicare prescription drug plans have a list of drugs they cover. Prescription medications are listed in tiers, which is a way to determine the cost of medicine. Tier 1 lists more generic, less expensive medications, and Tier 5 contains high-cost prescription drugs. The higher the tier, the more you will have to pay for your copayment.
Ozempic is on the list of most prescription drug plans, however, you should check your plan’s formulary to make sure Ozempic is listed and to check which tier it is in. The amount that you pay will depend on the details of your plan, your copay, and whether your deductible has been met.
Medicaid
To be eligible for Medicaid, you must be considered low or very low income. Ozempic and other GLP-1 antagonists are typically covered by Medicaid programs to treat type 2 diabetes.
However, coverage varies by state because each state Medicaid program has its own rules and requirements. Be sure to check with your state’s Medicaid agency for details about coverage for Ozempic.
Find the right dietitian for you
How to get insurance to cover Ozempic
Before getting Ozempic, it is important to make sure your insurance covers the medication. While most insurance providers cover Ozempic when prescribed for type 2 diabetes, you may have to prove your diagnosis. There are some steps you can take before receiving Ozempic to ensure that it is covered.
- Check your plan. You can start off by checking the prescription drug formulary of your insurance provider. You can always call your provider to check on the details of your coverage. You can also contact Novocare, which is a support program through Novo Nordisk, to find out what Ozempic will cost you.
- Get a prescription. Most insurance companies will provide at least some coverage for Ozempic if it is prescribed to treat type 2 diabetes.
- Check if you need prior authorization. Some prescription medications need approval from your health insurance provider before you receive them. Depending on your plan, you may not be covered without prior authorization. If you need Ozempic, be sure to contact your insurance provider as soon as possible to start the approval process.
- Request an appeal. Insurance may deny coverage for Ozempic at first, especially if it is for weight loss. While there is no guarantee, some insurance companies have loopholes to gain coverage. If necessary, you can write an appeal letter that includes the medical necessity of your medication outlined by your doctor, along with other supporting documents.
Is it possible to get Ozempic for free?
If you qualify, you may be able to get Ozempic at no cost through the Novo Nordisk Patient Assistance Program. To be eligible, you must be a US citizen or legal resident, have a total household income under a certain level, and have Medicare or no insurance. You also cannot qualify for any other federal, state, or government program such as Medicaid.
Why working with a dietitian while taking Ozempic is a good idea
There are many benefits to working with a dietitian, particularly when taking a medication like Ozempic. Ozempic was designed to work along with lifestyle modifications. If you are not following a healthy eating pattern and getting enough exercise, you might not lose weight while taking Ozempic or see the other benefits it’s supposed to bring.
By working with a registered dietitian, you can learn what a proper Ozempic diet looks like for managing your blood glucose and losing weight. Dietitians can help you understand your unique nutrition needs so you can feel confident in your decisions around food.
Another reason to work with a dietitian is to help manage potential side effects. Possible side effects of taking Ozempic include nausea, diarrhea, and constipation. Your dietitian can help you choose the best foods to help manage your symptoms.
Dietitians can help you lose weight by building you a custom nutrition plan that fits your lifestyle and preferences. This will set you up for long-term, sustainable results while taking Ozempic.
>> Read more: How long does it take to lose weight on Ozempic?
Find the right dietitian for you
Kamryn is a Registered Dietitian who specializes in performance nutrition and weight management. She has experience in a variety of settings as a dietitian, including sports, clinical, and private practice. She currently provides individualized nutrition and fitness coaching to adult men and women. Kamryn is passionate about using evidence-based nutrition strategies to help people achieve long-term success with their fitness goals and to maintain a healthier lifestyle.
Ozempic is an injectable medication that is prescribed to adults with type 2 diabetes. The generic name for Ozempic is semaglutide. Semaglutide works by mimicking a specific hormone (GLP-1) that is released in your gut after eating. This hormone helps your body produce more insulin, which lowers your blood sugar.
Ozempic can also help people lose weight. This is because the naturally occurring hormone, GLP-1, can slow down digestion and make you feel fuller. This can cause you to eat less and ultimately lead to weight loss. Wegovy is another brand name for semaglutide that is specifically prescribed for weight loss.
If you are considering taking Ozempic, you may be wondering if it’s covered by insurance.
When Ozempic is prescribed specifically for type 2 diabetes, most insurance plans cover Ozempic. However, it is typically not covered for weight loss. In that case, you may need to investigate other weight loss drugs such as Wegovy or Saxenda.
This guide goes over when insurance covers Ozempic, the cost of it, and alternatives if your insurance does not provide coverage.
When Ozempic is covered by insurance
If Ozempic is prescribed for managing type 2 diabetes, most private insurance plans will provide coverage. This is because this drug is FDA-approved specifically for the purpose of managing this medical condition. In some cases, Ozempic may be covered for pre-diabetes as well.
In most cases, Ozempic is also covered by Medicare, which provides coverage for people at least 65 years of age, who have disabilities, or who have end-stage renal disease. Several medications to treat diabetes, including Ozempic, are covered under Medicare Part D.
If you are eligible for Medicaid, you also may receive coverage. Like most plans, Medicaid only covers Ozempic for patients with type 2 diabetes. Whether or not Ozempic is covered by Medicaid will vary from state to state.
No matter what type of plan you have, you will need a prescription from your doctor specifically for type 2 diabetes to ensure Ozempic is covered by insurance. Even with coverage, you may still have some out-of-pocket expenses such as copays, deductibles, and coinsurance. This all depends on your specific insurance plan.
Cost of Ozempic with insurance
The cost of Ozempic depends on your insurance provider, the state you live in, and any copayments, deductibles, or coinsurance you may have. Any amount that you owe before your insurance provides coverage will depend on your specific plan.
You may qualify for assistance with your copayment through Novo Nordisk, the manufacturer of Ozempic. With an Ozempic savings card, you may save up to $150 for a one-month prescription, $300 for a two-month prescription, and up to $450 for a three-month prescription.
With this offer, you may even pay as little as $25 for a three-month supply of Ozempic. However, not everyone is eligible for this offer, and there are limitations. It is valid for up to 24 months and only for those who have commercial prescription insurance.
Find the right dietitian for you
When Ozempic is not covered by insurance
When Ozempic is used for weight loss, it is considered “off-label,” which means it is being used in a way that was not approved by the FDA. It is very difficult to get a health insurance company to cover off-label prescription medications.
Because Ozempic is an FDA-approved drug for treating type 2 diabetes only, most commercial insurance providers will not cover Ozempic if it is prescribed specifically for weight loss. Without prior authorization, which means your health insurance reviews and approves your medication in advance, you may not receive coverage for Ozempic.
Like commercial insurance providers, Medicare does not cover any medications for weight loss. In addition, very few states cover weight loss medications through Medicaid. If you are prescribed Ozempic and you do not have type 2 diabetes, you may be denied coverage.
Cost of Ozempic without insurance
The cost of Ozempic without insurance is around $935 for a one-month supply. What you end up paying may be affected by the dose you are prescribed, your pharmacy, and whether or not you are eligible for patient assistance programs.
If you have no insurance, Novo Nordisk offers a Patient Assistant Program, where Ozempic is provided at no cost to those who qualify. To be eligible, your total household income must be at or below 400% of the federal poverty level. You also cannot be enrolled in any other federal, state, or government program such as Veteran Affairs Benefits or Medicaid.
Alternatives if your insurance doesn’t cover Ozempic
As mentioned above, insurance companies will most likely not cover Ozempic if it is prescribed for a purpose other than diabetes. It can be difficult to get insurance to cover this drug if it is used for weight loss. If your insurance does not cover Ozempic, other similar medications may be a better option for you financially.
- Wegovy. Like Ozempic, Wegovy is an injectable medication used specifically for weight loss. It is not typically covered by health insurance, however, there are still some ways to receive coverage. If your employer-covered insurance does not cover medication to treat obesity, you may submit a request for coverage to increase your chances of gaining coverage. You can learn about the cost of Wegovy with and without insurance here, how long it takes to lose weight on Wegovy here, and ideal Wegovy diet plan here.
- Mounjaro. Mounjaro is a relatively new brand-name medication that is used to help manage type 2 diabetes. It may also trigger weight loss. Some insurance plans cover Mounjara, however, coverage varies from plan to plan. You can learn about the best diet while taking Mounjaro here.
- Rybelsus. Rybelsus is a semaglutide tablet prescribed to improve blood sugar. Most Medicare prescription drug plans and other insurance plans have this drug on their formulary. If you are eligible, you may receive a Rybelsus savings offer to pay as little as $10 for one month. You can learn about the best foods to eat on Rybelsus and which to avoid here.
- Trulicity. Trulicity is used along with diet and exercise by adults with type 2 diabetes to improve glycemic control. It is not a weight loss drug, but it may lead to weight loss for some people. Most Medicare prescription drug plans and insurance plans cover Trulicity. While you may still have a copay or other out-of-pocket expenses, you will most likely receive some sort of coverage. Note that there are important foods to avoid while taking Trulicity.
- Saxenda. Saxenda is an injectable prescription medication for adults who are overweight and have weight-related health issues. Insurance may or may not cover Saxenda, however, there are other ways to gain coverage. You may be able to receive coverage through your employer, if you have Medicaid, or if you are a government employee. You can learn more about the best diet while taking Saxenda here.
Reviewing Ozempic coverage for major types of health insurance plans
Whether or not you receive coverage for Ozempic will depend on your health insurance plan and your medical condition. While most major health insurance plans cover Ozempic for diabetes, the out-of-pocket expenses may vary.
Private or employer-sponsored health insurance plans
Private insurance plans usually have diabetes medications, such as Ozempic, on their formulary. If you have private insurance, you also may qualify for the Ozempic savings card to lower your costs even more.
Medications for weight loss are typically not covered by employer-sponsored health insurance plans. However, employers may cover Ozempic for type 2 diabetes. As with any insurance plan, coverage and out-of-pocket expenses will vary from plan to plan.
Medicare
Most Medicare prescription drug plans have a list of drugs they cover. Prescription medications are listed in tiers, which is a way to determine the cost of medicine. Tier 1 lists more generic, less expensive medications, and Tier 5 contains high-cost prescription drugs. The higher the tier, the more you will have to pay for your copayment.
Ozempic is on the list of most prescription drug plans, however, you should check your plan’s formulary to make sure Ozempic is listed and to check which tier it is in. The amount that you pay will depend on the details of your plan, your copay, and whether your deductible has been met.
Medicaid
To be eligible for Medicaid, you must be considered low or very low income. Ozempic and other GLP-1 antagonists are typically covered by Medicaid programs to treat type 2 diabetes.
However, coverage varies by state because each state Medicaid program has its own rules and requirements. Be sure to check with your state’s Medicaid agency for details about coverage for Ozempic.
Find the right dietitian for you
How to get insurance to cover Ozempic
Before getting Ozempic, it is important to make sure your insurance covers the medication. While most insurance providers cover Ozempic when prescribed for type 2 diabetes, you may have to prove your diagnosis. There are some steps you can take before receiving Ozempic to ensure that it is covered.
- Check your plan. You can start off by checking the prescription drug formulary of your insurance provider. You can always call your provider to check on the details of your coverage. You can also contact Novocare, which is a support program through Novo Nordisk, to find out what Ozempic will cost you.
- Get a prescription. Most insurance companies will provide at least some coverage for Ozempic if it is prescribed to treat type 2 diabetes.
- Check if you need prior authorization. Some prescription medications need approval from your health insurance provider before you receive them. Depending on your plan, you may not be covered without prior authorization. If you need Ozempic, be sure to contact your insurance provider as soon as possible to start the approval process.
- Request an appeal. Insurance may deny coverage for Ozempic at first, especially if it is for weight loss. While there is no guarantee, some insurance companies have loopholes to gain coverage. If necessary, you can write an appeal letter that includes the medical necessity of your medication outlined by your doctor, along with other supporting documents.
Is it possible to get Ozempic for free?
If you qualify, you may be able to get Ozempic at no cost through the Novo Nordisk Patient Assistance Program. To be eligible, you must be a US citizen or legal resident, have a total household income under a certain level, and have Medicare or no insurance. You also cannot qualify for any other federal, state, or government program such as Medicaid.
Why working with a dietitian while taking Ozempic is a good idea
There are many benefits to working with a dietitian, particularly when taking a medication like Ozempic. Ozempic was designed to work along with lifestyle modifications. If you are not following a healthy eating pattern and getting enough exercise, you might not lose weight while taking Ozempic or see the other benefits it’s supposed to bring.
By working with a registered dietitian, you can learn what a proper Ozempic diet looks like for managing your blood glucose and losing weight. Dietitians can help you understand your unique nutrition needs so you can feel confident in your decisions around food.
Another reason to work with a dietitian is to help manage potential side effects. Possible side effects of taking Ozempic include nausea, diarrhea, and constipation. Your dietitian can help you choose the best foods to help manage your symptoms.
Dietitians can help you lose weight by building you a custom nutrition plan that fits your lifestyle and preferences. This will set you up for long-term, sustainable results while taking Ozempic.
>> Read more: How long does it take to lose weight on Ozempic?
Find the right dietitian for you
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