Is Ozempic Covered by Insurance? How Much Does it Cost?

Ozempic (semaglutide) is an FDA-approved medication that treats Type 2 diabetes. On average, the retail price ranges anywhere from $1,000 to $1,200 or more for one pen, depending on the pharmacy you visit.

If you have health insurance, you may be able to get Ozempic covered if it’s being used as a treatment for Type 2 diabetes. But you may not get coverage if you want to use the medication for weight loss.

If your insurance doesn’t cover Ozempic, check your plan’s formulary to see if there are alternative medications for weight loss and managing Type 2 diabetes that are covered.

Key Takeaways

• Ozempic is an FDA-approved medication for treating Type 2 diabetes that costs $1,000-$1,200 per pen without insurance.
• Health insurance may cover Ozempic for diabetes treatment, but likely won’t cover it for weight loss purposes.
• Without insurance, the Novo Nordisk patient assistance program or prescription coupons can reduce Ozempic’s cost.
• Alternative medications like Trulicity and Victoza offer similar benefits to Ozempic at a lower cost.

What is Ozempic?

Ozempic is classified as a GLP-1 agonist, a type of medication that imitates the actions of a gut hormone known as GLP-1. These medications reduce blood glucose levels following meals and inhibit glucose production in the liver.

GLP-1 is believed to directly impact the brain’s appetite control region and specific hunger hormones. So, by replicating the effects of GLP-1, Ozempic also suppresses appetite and induces a sensation of fullness, reducing calorie intake and increasing weight loss.

What factors affect the cost of Ozempic?

The list price for Ozempic is approximately $936 per pen. But most people pay the retail price and not the list price. On average, the retail price for a pen ranges anywhere from $1,000 to $1,200 or more, depending on the pharmacy you visit.

The cost of Ozempic can be affected by many factors, including:

• Your location
• The pharmacy you choose
• The dosage you’re prescribed
• Your insurance coverage
• Your eligibility for patient assistance programs

Since Ozempic is intended for long-term use, the costs can add up over time. And a generic version doesn’t exist, so Ozempic prices have remained high. But you can save money by using a GoodRx coupon and manufacturer discounts if you’re eligible.

How much does Ozempic cost with insurance?

Whether your insurance covers Ozempic depends on your plan and medical condition. For example, your insurance may cover the medication if you have Type 2 diabetes, but you may have a copay or other out-of-pocket costs based on your plan.

However, your insurance may not cover Ozempic at all if it’s being taken for weight loss. Most plans only pay for costs associated with weight-related health problems once they develop — not weight-loss treatments to prevent health issues from occurring.

Below, read about how various insurance providers approach coverage for Ozempic.

Private or employer-sponsored insurance

In general, weight-loss medications are not widely covered by employer-sponsored plans in the U.S. Data from the International Foundation of Employee Benefit Plans (IFEBP) indicates that only 22% of employers cover prescription medications for weight loss. Private insurance plans are only required to cover obesity screening and counseling under the Affordable Care Act’s (ACA) essential health benefits.

Even if your insurer covers a specific medication for weight loss, like Ozempic, you may have to meet certain criteria for the medication to be considered medically necessary, such as having a minimum body mass index (BMI) and making behavioral modifications.

Novo Nordisk, the manufacturer of Ozempic, has an online tool to help determine the cost of Ozempic with your insurance plan. A representative will review your benefits and give you an estimate over the phone or online. But you must have your prescription insurance card details available to get assistance.

If you have private or commercial insurance, you may be able to pay as little as $25 for a monthly supply of Ozempic with the help of a savings card. This offer is valid for up to 24 months and could lead to savings of up to $150 on a 1-month prescription of Ozempic.

Medicare

Medicare insures people who are 65 or older, certain younger people with disabilities, and individuals with end-stage renal disease. Medicare Part D covers a variety of antidiabetic medications. So if you have Medicare, check the details of your prescription medication coverage to see if Ozempic is covered. With Medicare Advantage plans, most policies include Medicare Part D prescription medication coverage.

However, Medicare doesn’t cover anti-obesity medications. Congress prohibited the program from covering obesity treatments as part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006.

Medicaid

Medicaid provides health coverage to more than 72.5 million Americans, including children, pregnant women, low-income families, and people with disabilities. All states currently offer outpatient prescription medication coverage as part of their Medicaid programs.

91,521,722 individuals were enrolled in Medicaid and CHIP in the 51 states and the District of Columbia that reported enrollment data for July 2023. 84,504,888 individuals were enrolled in Medicaid. 7,016,834 individuals were enrolled in CHIP.

https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html#:

However, each state has its own rules and requirements around things like prior authorizations, step therapy, and quantity limits. Contact your state’s Medicaid agency for details about your plan and whether Ozempic is covered.

How to get Ozempic covered by insurance

Though most insurance providers cover Ozempic for Type 2 diabetes, you may have to prove you have the condition before your plan will pay for the medication. Below are four steps you can take to increase the chances of getting Ozempic covered by your insurance:

• Review your health insurance plan. You can reach out to your insurance provider to get a better understanding of what’s covered by your plan. You can also review your plan’s formulary to see if Ozempic is listed as a covered medication.
• Get a prescription. Ozempic is a prescription-only medication for adults with Type 2 diabetes. You can schedule an appointment with your healthcare provider to discuss your medical condition, the potential benefits of Ozempic, and the possibility of getting a prescription.
• Obtain prior authorization if needed. If your insurance company requires a prior authorization for Ozempic, your doctor may need to provide confirmation that you have Type 2 diabetes and that the medication is medically necessary for treatment.
• Request an appeal if necessary. If your insurance provider denies your initial request for coverage, you may appeal to reverse the decision. Review your health insurance plan details and the reason for the denial, so that you can write a solid appeal letter.

Can you get Ozempic free?

Yes, you can obtain some medications at no cost through the Novo Nordisk Patient Assistance Program, if you qualify. More than a dozen medications are on the list of covered products, including Ozempic. To be eligible for the program, you must meet several requirements, including:

• Being a U.S. citizen or legal resident
• Falling below a certain income level
• Having Medicare or not having insurance

You can apply for the patient assistance program online.

Ozempic alternatives

Although there is not a generic version of Ozempic on the market, there are alternative medications for managing Type 2 diabetes. There are also FDA-approved medications for weight loss. The following table includes some of these medications and their FDA-approved use.

Whether and how much of the cost of these Ozempic alternatives are covered depends on your insurance plan and provider. For example, even if your policy covers weight-loss medications, it may only pay for specific ones. And there could be a high copay or the need for a prior authorization, depending on the medication.

The bottom line

Most insurance plans cover Ozempic (semaglutide) when it’s used as a treatment for Type 2 diabetes. When it’s used for weight-loss purposes, however, it’s much less likely to be covered. But you may be able to find an alternative medication for chronic weight management that’s more affordable, if your insurance provider offers weight-loss medication coverage.

How much does Ozempic cost without insurance?

Ozempic costs about $900 for a one-month supply but there are ways to reduce those costs.

Some insurance providers will cover some or all of the cost of the medication, depending on the level of coverage you have and the condition for which the medication is being prescribed.

Where to get Ozempic without insurance

• Ro – Offers Ozempic through its Body Program which takes a holistic approach to weight loss. Does not accept insurance for this program.
• PlushCare – Offers Ozempic to people with and without insurance. Requires an online doctor visit first. Offers Ozempic for type 2 diabetes treatment starting at $949 without insurance. Accepts many insurance plans to lower costs.
• K Health – Provides personalized weight loss plans, including potential Ozempic prescription. Costs $49/month, works with insurance to maximize coverage.

How to save on Ozempic without insurance

• Novo Nordisk savings card – Save up to $450 on 3-month supply with commercial insurance. For diabetes treatment only.
• Novo Nordisk patient assistance program – Get Ozempic for free if you have Medicare, no insurance, and income below 400% of federal poverty level.
• Prescription coupons/cards – Companies like Optum Perks and GoodRx offer coupons and discounted rates on Ozempic.
• Compare pharmacy prices – Costs can vary significantly between pharmacies. Compare to find the best cash price.
• Buy in bulk – Buying a 90-day supply from some pharmacies can lower the cost per dose.

Does insurance cover Ozempic?

• Private insurance may cover it for diabetes treatment with restrictions, copays, and deductibles. Unlikely to cover for weight loss.
• Medicare Part D plans often cover it for diabetes. Medicare does not cover for weight loss.
• Medicaid covers prescription drugs with state-specific rules. Check your state’s plan for Ozempic coverage details.
• Manufacturer savings programs only apply if insurance covers Ozempic for diabetes treatment.

How much does Ozempic cost with insurance?

Ozempic cost with insurance will vary by plan. With the manufacturer’s savings card, you may pay as little as $25 per month if covered by private insurance for diabetes. Without coverage, Ozempic costs over $900 per month on average. Ways to reduce costs include:

• Checking if insurance covers Ozempic and to what extent
• Using the Novo Nordisk savings card if eligible
• Comparing pharmacy prices for the best rates
• Trying coupons and discount cards
• Considering alternative GLP-1 diabetes medications
• Exploring other insurance options that cover Ozempic

Ozempic is expensive without adequate insurance. But there are ways to lower costs through insurance coverage optimization, manufacturer assistance programs, pharmacy price comparisons, and discussing alternatives with your doctor.

How To Get Ozempic Covered by Insurance

Getting health insurance to cover Ozempic for type 2 diabetes management can be challenging. Here are some tips:

• Review your health plan details to understand current coverage
• Get a prescription from your doctor for Ozempic for diabetes treatment
• If required, obtain prior authorization from your insurer proving medical need
• Appeal any denials by highlighting Ozempic’s benefits for your condition
• Check if you qualify for Novo Nordisk’s savings card to lower copays
• See if alternative GLP-1 drugs like Trulicity or Victoza are covered
• Apply for Novo Nordisk’s patient assistance if you meet eligibility criteria
• Consider exploring marketplace insurance plans that cover Ozempic
• Ask your doctor about more affordable generic diabetes medications
• Compare pharmacy prices, use coupons/cards to find the lowest costs

With persistence and a thorough understanding of your options, you can hopefully get Ozempic covered affordably. Discuss all avenues with your healthcare provider to find the optimal treatment solution for your diabetes.

How Much Does Ozempic Cost Without Insurance?

Without insurance, Ozempic can cost over $900 per month or about $2,500 yearly. The exact cost depends on:

• Location and specific pharmacy used
• Dosage prescribed
• Available coupons and savings

There is currently no generic Ozempic available. Even with insurance, you may have deductibles or copays.

Ways to get Ozempic without insurance:

• Novo Nordisk patient assistance program – get Ozempic free if eligible
• Apply for Medicaid if income requirements are met
• Shop for an affordable health insurance plan
• Use prescription discount cards and coupons
• Order a 90-day supply from some pharmacies for lower cost per dose

Alternatives for lower cost:

• Metformin, sulfonylureas, etc. – affordable generic diabetes drugs
• Other GLP-1 agonists like Trulicity or Victoza
• Discuss options with your doctor to find the right treatment

Getting Ozempic without insurance can be very expensive. But there are ways to reduce costs through prescription assistance programs, insurance enrollment, coupons, and considering generic and therapeutic alternatives.

Frequently Asked Questions

How much does Ozempic cost with insurance?

With insurance, Ozempic typically costs $25-$50 per month depending on your plan’s prescription drug coverage and associated copays.

Does Medicare/Medicaid cover Ozempic?

Medicare Part D and most Medicare Advantage plans cover Ozempic for diabetes treatment. Medicaid coverage varies by state. Neither covers it for weight loss.

How can I get Ozempic for free?

You may be able to get Ozempic for free through the Novo Nordisk patient assistance program if you meet eligibility requirements.

What are cheaper alternatives to Ozempic?

Other GLP-1 drugs like Trulicity, Victoza, and Bydureon are alternatives that cost less than Ozempic. Metformin is an affordable generic diabetes medication.