Is Ozempic covered by Medicare and Medicaid?

Yes, Ozempic is usually covered under Medicare and state Medicaid programs to treat approved indications like type 2 diabetes, cardiovascular risk reduction and chronic kidney disease in type 2 diabetes, but not for weight loss, which is not approved by the FDA. Coverage can differ among participants and states, so it’s best to check directly with your plan.

Does Medicare pay for Ozempic?

Yes, most Medicare prescription drug plans (Medicare Part D) cover Ozempic for the treatment of approved indications like type 2 diabetes or for prevention of chronic kidney disease in people with type 2 diabetes, but not for weight loss. Coverage can change yearly, so it's best to check directly with your plan.

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.

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. In 2025, the Medicare Part D spending cap (out of pocket costs) for patients will be set at $2,000 annually.

Learn more: Will my private health insurance cover the cost of Ozempic?

What if I want Ozempic for weight loss?

The 2003 Medicare Part D law specifically excludes coverage of weight loss drugs.

Ozempic is approved for the treatment of type 2 diabetes but not specifically for weight loss (even though it causes weight loss in this group of patients). It is also approved to reduce the risk of major cardiovascular events (like a stroke or heart attack) in adults; as well as to reduce the risk of worsening kidney disease, kidney failure (end-stage kidney disease) and cardiovascular death in adults with type 2 diabetes and chronic kidney disease.

• Some doctors may prescribe Ozempic “off-label” for weight loss, but your insurance probably will not cover it.
• "Off-label" use of a drug refers to when a doctor prescribes a drug for a different purpose than those formally approved by the FDA and found in the package labeling of the drug.

However, there are other options that Medicare may cover for weight loss if you qualify.

In March 2024 the FDA approved Wegovy (semaglutide) for cardiovascular risk reduction in people with either obesity or overweight. Ozempic and Wegovy, both manufactured by Novo Nordisk, work the same way but have slightly different dosages and are approved for different uses. They are both GLP-1 agonists that contain semaglutide, the same active ingredient that's found in Ozempic.

This means people on Medicare with documented heart disease and weight concerns may now qualify for Wegovy coverage.

Contact your Medicare Part D drug plan to determine your eligibility for Ozempic or Wegovy. Your doctor’s office may be able to assist in this, as well.

In some cases, you may have to follow a stepped-plan, where you have to try other treatments first, before Ozempic or Wegovy would be approved. Your doctor may also need to fill out special insurance paperwork called a "Prior Authorization" to request coverage.

Related questions

• Mounjaro vs Ozempic: Which is right for you?
• Ozempic Side Effects to Watch For
• How do Ozempic, Mounjaro, Wegovy, Zepbound compare for weight loss?

Does Medicaid cover Ozempic?

Most GLP-1 agonists, including Ozempic, are usually covered by state Medicaid programs for the treatment of type 2 diabetes. You can review your state's Medicaid drug formulary online to see if Ozempic, or another GLP-1 agonist, is covered. Your doctor may know, too.

Medicaid is a U.S. 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.

Some states, such as North Carolina, have included GLP-1's like Wegovy for weight loss on their Medicaid drug formulary, so it's always best to check directly. Other states that include GLP-1s for obesity treatment (as of Aug. 2024) include California, Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, New Hampshire, Pennsylvania, Rhode Island, Virginia and Wisconsin.

For Medicaid, you may still need to meet certain qualifications to be prescribed these drugs for weight loss, even if your state covers them. This may include prior authorizations and meeting certain body-mass index (BMI) targets, which is a number that estimates your body fat based on your height and weight.

What is the cash price for Ozempic?

If you are paying cash for Ozempic, you might be able to save some money by using an online coupon but the cost may still be too high. The cash price for Ozempic is about $1051 per month using an online coupon.

• Related: See the Ozempic Price Guide for costs, coupons and patient financial assistance options.

Ozempic is normally used as a long-term treatment for type 2 diabetes, and costs can add up if you must pay a significant amount each month. There are no FDA-approved generic alternatives for Ozempic at this time.

Novo Nordisk, the manufacturer of both Ozempic and Wegovy may also be able to offer a Patient Assistance Program (PAP) or recommend nonprofit agencies that can provide financial support.

• Patient assistance programs for Ozempic provide free or lower-cost medications to people who cannot afford to buy their medicine.
• People on Medicare and people paying cash, who qualify financially, may be eligible.
• You can apply online at Novocare.com or contact them at 1-866-310-7549.

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.