Will my insurance cover Ozempic?

Most prescription plans cover some or all of the cost for Ozempic when used to treat type 2 diabetes, but it’s not frequently covered for weight loss. The cost for Ozempic typically runs between $0 and $1029 per month. Your final cost will depend on your insurance plan benefits and any deductibles, co-insurance or copays you may have.

You can also call Novocare, a support program from the manufacturer Novo Nordisk, to determine your cost estimate for Ozempic by phone or online.

• Call 1‑844‑Novo4Me (1‑844‑668‑6463) Monday-Friday, 8:00 am to 11:00 pm, and Saturday, 11:00 am to 7:00 pm EST
• If you prefer, you can complete an online form on the Novocare website to get a quick response, usually in minutes. This service is available 24 hours per day, 7 days per week.
• You will need to provide your insurance information, your provider's name and some personal identification information.

Commercial or private insurance plans are usually provided by your employer or from the Health Insurance Marketplace Plans. They are not government-funded plans like Medicare, Medicaid, CHIP or Tricare, for example.

What are Ozempic and Wegovy approved for?

Ozempic (semaglutide) is approved by the FDA:

• For adults with type 2 diabetes to lower blood glucose (sugar), along with diet and exercise.
• To reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.

Wegovy (semaglutide) is approved by the FDA for chronic (long-term) weight management in adults and children 12 years and older, along with diet and exercise.

• Adults should have an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related health condition (for example: high blood pressure, type 2 diabetes mellitus, or high cholesterol).
• Children 12 years and older should have an initial BMI at the 95th percentile or greater for age and sex (obesity).
• Wegovy is also approved reduce the risk of heart attack, stroke and heart-related death in people with cardiovascular (heart, blood vessel) disease.

Ozempic and Wegovy both contain semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, but their doses are different. Semaglutide mimics the action of the natural hormone GLP-1 in your body that helps your body keep blood sugar in balance.

These medicines are given as once-weekly subcutaneous injections (by a needle under the skin) in your stomach (abdomen), thigh, or upper arm area. Your healthcare provider will teach you how to use this medicine.

Is Ozempic covered for weight loss?

• Most insurance companies cover Ozempic when it’s prescribed to treat type 2 diabetes, but not for weight-loss.
• Ozempic use for weight loss is considered “off-label” and is not approved by the FDA. Insurance companies may not pay for “off-label” or unapproved uses of drugs.

If your doctor prescribes Ozempic “off-label” for weight loss, but your insurance will not cover it, you may have other options.

• Wegovy is a weekly GLP-1 agonist injectable medicine approved for weight loss that contains the same active ingredient as Ozempic, called semaglutide, but in a higher dose. Saxenda (liraglutide) is another weight loss drug in the same class as Wegovy and Ozempic.
• Check with your prescription plan to see which drugs, if any, are covered for weight loss when prescribed by your doctor. Your insurance may help to cover programs for behavioral change, nutrition and exercise planning.
• Speak to your healthcare provider to determine which weight loss treatments may be a good option for you.

Because these drugs are typically used long-term for weight loss, costs can add up if you must pay a significant amount each month. There are no generic alternatives for Ozempic or Wegovy at this time.

How can I save on Ozempic? How can I get help paying for Ozempic?

Novo Nordisk, the manufacturer of Ozempic, may be able to offer you copay assistance if you have commercial insurance. You could pay as little as $25 for up to a 3-month supply of Ozempic. To receive this offer, your prescription must be for a 1-, 2-, or 3-month supply for the treatment of type 2 diabetes.

• For eligible people with commercial (private) insurance that covers Ozempic, the Novo Nordisk Savings card can offer a maximum savings of $150 for a 1-month prescription, $300 for a 2-month prescription, and $450 for a 3-month prescription. This offer is good for up to 24 months.
• Copay assistance is not valid for people using government-assisted programs, such as Medicare, Medicaid, VA, Tricare or any similar federal or state health care program. People paying full cash for Ozempic are also excluded.
• If you do not have insurance, Novo Nordisk may be able to offer patient financial assistance for Ozempic based on your income eligibility. Patient assistance programs provide free or lower-cost medications to people who cannot afford to buy their medicine.

Copay assistance is usually for people with commercial prescription insurance, while patient financial assistance is typically for people who meet certain lower income requirements.

Many pharmaceutical companies have information about patient assistance programs listed on their website. Call them or look on their websites to see what options are offered.

If you are paying cash for Ozempic, you might be able to save some money by using an online coupon for Ozempic, although it's cost may still be high.

Related: View the Ozempic Price Guide for costs, coupons and patient financial assistance options

Does private (commercial) insurance cover Ozempic?

Most private (commercial) insurance companies cover Ozempic for type 2 diabetes, but different insurance plans cover different medicines, and this can change over time. Your coverage and cost depends on your plan and plan benefits.

• When you call your insurance company, ask them what “tier” Ozempic falls under and what your copay is, which can differ based on your plan benefits. You may also have a deductible or co-insurance.
• Ask them if Ozempic is covered for types 2 diabetes and / or weight loss, depending upon your need.

Insurance plans usually have 4 or 5 tiers for medicines. Costs can range from the lowest (on Tier 1, usually generic drugs), to the highest on Tier 4 or 5 (non-preferred brands or specialty drugs).

Quite often, your insurance may prefer one or two drugs in a particular drug class or group because they can get it at a more affordable rate.

You can usually access your insurance company drug formulary on their website. A formulary is a list of drugs, and their tiers, covered by your insurance. If you still have questions, contact your insurance company directly.

If you have a prescription, your pharmacist can also tell you your copay and suggest what alternatives you might have if you can't afford the medication.

In some cases you may be responsible for a large portion of the cost of Ozempic, even with private or commercial insurance.

Related: How do Mounjaro, Wegovy & Ozempic compare for weight loss?

Related Questions

• What are 4 key Ozempic side effects to watch out for?
• Mounjaro vs Ozempic: How do they compare?
• How do Ozempic, Mounjaro, Wegovy, Zepbound compare for weight loss?

Is Ozempic covered by Medicare?

Yes, most Medicare prescription drug plans (Medicare Part D) cover Ozempic for the treatment of type 2 diabetes, but not for weight loss.

Coverage can change yearly, so it's best to check directly.

Medicare offers prescription outpatient drug coverage (Medicare Part D) if you are 65 years of age or older or have certain disabilities What you pay will depend upon your benefits and if you have met your yearly deductibles or hit the coverage gap.

• In 2024, you’ll hit the Medicare Part D coverage gap ("donut hole") when the medications costs spent by you and your prescription plan equal $5,030 in total for the year.
• If you are in the coverage gap, you may be responsible for up to 25% of the cost of your prescriptions.
• Then, once you’ve spent $8,000 out-of-pocket for the year (for 2024), you’ll enter catastrophic coverage and Medicare will pay for most of the costs of your medicines for the rest of the plan year. These costs can change from year-to-year.
• The Inflation Reduction Act (IRA) signed into law by the Biden Administration in 2022 will eliminate the coverage gap for people on Medicare in 2025.

Does Medicaid cover Ozempic?

Most GLP-1 agonists, including Ozempic, are usually covered by state Medicaid programs for the treatment of type 2 diabetes. Medicaid is a US government-run health insurance program that provides medical assistance for eligible low-income individuals and families, pregnant women and people with certain disabilities.

Prescription coverage for Medicaid plans is often determined by individual states. Many states may not cover weight-loss drugs for Medicaid recipients, or may have special requirements before coverage begins. Contact your individual state plan to determine eligibility for weight-loss medications.

What are some alternatives to Ozempic for weight loss?

GLP-1 agonist alternatives that are approved for weight loss include:

• Saxenda (liraglutide) injection
• Wegovy (semaglutide) injection
• Zepbound (tirzepatide) injection

Mounjaro (tirzepatide) is an injection used weekly to lower blood sugar in type 2 diabetes and has also been shown in studies to be useful for weight loss, but it is not approved for this use. Zepbound is the brand name version of tirzepatide that is approved for weight loss.

In addition to Ozempic, other injected GLP-1 agonists approved for type 2 diabetes treatment include:

• Adlyxin (generic name: lixisenatide)
• Bydureon BCise (generic name: exenatide)
• Byetta (generic name: exenatide)
• Trulicity (generic name: dulagutide)
• Victoza (generic name: liraglutide)

If you prefer an oral GLP-1 treatment, Rybelsus is a once-a-day tablet formulation of semaglutide, first approved in Sept. 2019 for adults with type 2 diabetes mellitus to control blood sugar levels.

Tips for getting Ozempic (or other medicines) for weight loss

1. Research your health plan: Many health plans do not include coverage for any weight loss drugs, although some are starting to cover these medicines. Contact your insurance and ask which medicines are included on the formulary for chronic weight loss and ask about your monthly copay. It may be best to determine which medicines your insurance will cover before you see your doctor.
2. Make an appointment: Except for alli (orlistat) which is an over-the-counter (OTC) weight loss pill, all weight loss medicines require a prescription, so make an appointment to discuss your treatment options with your healthcare provider. In some cases, you may not be able to use weight loss medications for medical or other reasons.
3. Discuss alternatives: Ozempic is not approved as a weight loss treatment. Your insurance may only cover Ozempic when prescribed to treat type 2 diabetes, its FDA-approved use. If this is the case, discuss other approved options with your healthcare provider - including approved GLP-1 weight-loss alternatives, such as Wegovy, Zepbound or Saxenda.
4. Prior authorization: If your doctor prefers that you receive Ozempic, they may need to complete a Prior Authorization form to be reviewed and approved by your insurance company. This form will help explain the medical reason why you need Ozempic over other options. This can help increase the chances that your insurance will cover some of the costs for the medicine. If Prior Authorization is rejected, there is usually an appeal process, as well.

Are weight loss ("diet) pills still used?

Prescription weight loss pills, sometimes called “diet pills”, may also be prescribed for some patients.

• Weight loss drugs that suppress the appetite are known as anorexiants and contain a stimulant medication similar to amphetamine. They are only for short-term use and are used in addition to diet and exercise.
• Stimulants are classified as controlled substances by the Drug Enforcement Agency (DEA) because they have a risk for abuse and addiction. Because of this risk, many doctors prefer not to prescribe these medications for weight loss.

Anorexiants include:

• Adipex-P, Lomaira (generic name: phentermine)
• Benzphetamine
• Bontril PDM (generic name: phendimetrazine)
• Diethylpropion
• Qsymia (generic name: phentermine and topiramate)

Other non-stimulant weight loss options include:

• alli or Xenical (generic name: orlistat) - alli is available over-the-counter (OTC) without a prescription.
• Contrave (generic name: bupropion and naltrexone)
• Plenity (generic name: cellulose / citric acid).

Related: Weight Loss and Diet Pills: Options to Know

This is not all the information you need to know about Ozempic (semaglutide) for safe and effective use and does not take the place of your doctor’s directions. Prices or insurance coverage are subject to change at any time. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.