Ozempic (semaglutide) is an injectable medication prescribed to control blood sugar levels in adults with Type 2 diabetes. It is also used to decrease the risk of heart attack and stroke for those with Type 2 diabetes and heart disease.
Recently, the medication has entered mainstream consciousness after several celebrities have used the drug to lose weight. While weight loss is often a side effect of Ozempic (as with related drugs Wegovy and Rybelsus), Ozempic is not yet approved by the FDA to treat obesity.
Ozempic Costs without Coverage
Without insurance coverage, Ozempic costs roughly $900 to $1,100 per month. Novo Nordisk, Ozempic’s manufacturer, offers a savings program available to those with private or commercial insurance.
Medicare Coverage of Ozempic
Since Medicare has several parts, coverage for Ozempic will vary; however, most Part D plans (including those bundled with Medicare Advantage plans) will offer coverage.
Medicare Parts A and B
Medicare Part A covers inpatient hospital care, skilled nursing facility care, and some home health care. Medicare Part B covers outpatient care, including doctor's visits, preventive services, and some prescription drugs.
In the majority of cases, Ozempic is not covered by Medicare Part A or B for the treatment of Type 2 diabetes. However, if you are admitted to the hospital and you receive Ozempic as part of your treatment, Medicare Part A may cover the cost of the medication.
More often, a Part D prescription drug plan will cover Ozempic, as these plans cover outpatient prescription drugs.
Medicare Part D
Medicare Part D covers prescription drugs, and Ozempic is often covered under Medicare Part D. That said, not all Medicare Part D plans cover Ozempic. You will need to check your plan's formulary to see if Ozempic is covered.
If Ozempic is covered by your plan, you will still have to pay a copay or coinsurance for the medication. The amount of your copay or coinsurance will vary depending on your plan.
Medicare Advantage plans, a private alternative to Medicare Parts A and B, will not necessarily cover Ozempic for the treatment of Type 2 diabetes. To qualify for this coverage, your Medicare Advantage plan will need to include a Part D plan. In these cases, the coverage for Ozempic will be similar to that of a person with Original Medicare and a stand-alone Part D plan.
In some rare cases, if you have a serious medical condition that is directly related to your obesity, Medicare may cover the cost of Ozempic if your doctor determines that it is medically necessary.
How to Find Out If Medicare Covers Ozempic
The best way to find out if Medicare covers Ozempic is to contact your plan directly. You can also check your plan's formulary online. If you are not sure which plan you have, you can contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227).
As of 2023, Medicare covers Ozempic for the treatment of Type 2 diabetes, but not for weight loss. If you are considering using Ozempic for weight loss, you should talk to your doctor about whether it is right for you.
A 2003 law that established the Part D prescription drug program explicitly prohibits Part D plans from covering drugs used for weight loss. This same bill also prevents Part D plans from covering hair loss drugs, fertility drugs, and drugs designed to treat erectile dysfunction.
As the Medicare expert for Medigap.com, Lindsay Malzone has ample experience helping seniors understand the ins and outs of their Medicare coverage and navigating the complex world of supplemental insurance. She has written for a variety of web publications based on her Medicare expertise. Ultimately, her passion lies in helping people find the right healthcare for their needs.