Since Ozempic is a prescription drug, Medicare Part D may cover it. Private insurance companies provide part D plans and coverage for various prescription medications. However, coverage and cost-sharing requirements may vary among Part D plans, so reviewing your specific plan's formulary and coverage details is best.
Medicare covers Ozempic for Type 2 diabetes
Medicare prescription drug plans might cover Ozempic, but only to treat diabetes. In 2021, Medicare spent over $2.6 billion to cover Ozempic prescriptions. Because it's an outpatient prescription drug, Ozempic falls under Medicare Part D.
Medicare doesn't cover Ozempic (or Wegovy) for weight loss
That means unless you have another source of coverage, you'd need to pay out of pocket for a semaglutide prescription for weight loss, whether it's branded Ozempic or Wegovy.
Medicare covers Ozempic for Type 2 diabetes
Medicare prescription drug plans might cover Ozempic, but only to treat diabetes. In 2021, Medicare spent over $2.6 billion to cover Ozempic prescriptions. Because it's an outpatient prescription drug, Ozempic falls under Medicare Part D.
How to Get Prescription Assistance. To find out what Ozempic prescription assistance programs might be available to you, apply online or call Simplefill today at 1(877)386-0206. One of our advocates will contact you within 24 hours to conduct a telephone interview.
If you have private or commercial insurance, such as insurance you receive through an employer, you may be eligible to pay as little as $25 for a 1-, 2-, or 3-month prescription (maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription).
That said, when Ozempic is prescribed off-label for weight loss, it is often not covered by insurance. Why? Because the Affordable Care Act doesn't mandate that health insurers cover obesity or overweight medications or surgeries.
If you qualify for insurance coverage, Ozempic can cost as little as $25 for a monthly supply. However, without insurance, Ozempic costs around $892.06 per month, on average (NovoCare-a, 2022).
Overseas-registered Ozempic is available
While the Australian-registered Ozempic is subsidised on the Pharmaceutical Benefits Scheme (PBS), the overseas-registered products currently are not.
Ozempic is only approved for Type 2 diabetes. Since diabetes is a chronic health condition, you'll typically need to take Ozempic long-term to keep your blood glucose under control. You also likely need to continue taking Ozempic to maintain its heart-related benefits.
Novo Nordisk offers a patient assistance program for people who don't have insurance or who have insurance through Medicare. Those who qualify may receive the medication at no cost.
A licensed healthcare professional (such as a doctor) will evaluate your health. If they determine that Ozempic may be right for you, they'll provide an electronic prescription. You can then order the medication through the service.
The cost for Ozempic subcutaneous solution (2 mg/1.5 mL (0.25 mg or 0.5 mg dose)) is around $995 for a supply of 1.5 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.
Metformin is a widely used first-line medication for treating type 2 diabetes and can also be considered a lower-cost alternative to semaglutide (Ozempic).
Is there a cheaper substitute for Ozempic? Victoza (liraglutide) is another GLP-1 agonist that is similar to Ozempic but is less expensive. Other diabetes medications are also much less expensive, such as metformin, glipizide, or insulin.
A person can stay on Ozempic® so long as they are tolerating the medication and it is deemed appropriate by their treating provider. There is no specific time frame when someone should stop taking Ozempic as it is a medication that is intended for chronic (long-term) use.
Medicare covers Ozempic for Type 2 diabetes
In 2021, Medicare spent over $2.6 billion to cover Ozempic prescriptions. Because it's an outpatient prescription drug, Ozempic falls under Medicare Part D. Original Medicare (Part A and/or Part B) won't cover it.
Is Ozempic available for those without diabetes? Ozempic is only approved by the FDA for the treatment of type 2 diabetes. People who don't have diabetes may be able to take Ozempic “off-label” with a prescription from their doctor. “Off-label” means for use other than what is approved by the FDA.
If you take Wegovy or Ozempic to lose weight, will you need to keep taking the drugs indefinitely? Yes. As with many chronic conditions, most people who use the drugs for diabetes or weight loss will need to keep taking them to keep benefiting from them.
This carton containing 2 pens can last you a whole month. You would only need this pen if your doctor has prescribed you the higher dose of 1 mg per week of Ozempic injection. Your Ozempic pen should be stored in the refrigerator (between 36°F to 46°F or 2°C to 8°C) until the first time you use it.
So, on average, with the recommended starting Ozempic dose of 0.25 mg, a 500 to 1000 calorie reduced diet, and exercise 3 times a week, you can expect to lose 3-5 pounds in the first month of treatment, which works out to about 3% of body weight for most overweight or obese individuals.
How much weight will I lose with Ozempic? About a third of people who take Ozempic for weight loss will lose 10% or more of their body weight. Most people should expect to lose at least 5% of their starting body weight when using Ozempic for weight loss.
A disease, not cosmetic
Ozempic costs between $200 and $300 per month in Canada. Its manufacturer, Novo Nordisk, also got Health Canada approval in 2021 for a drug called Wegovy. Ozempic and Wegovy have the identical active ingredient — semaglutide — but Wegovy is a higher dose to specifically treat obesity.
Ozempic stimulates the release of insulin and lowers blood sugar. When you abruptly stop using it, the amount of glucose in your body can spike, especially if you have diabetes. Some may end up in the ER due to sheer exhaustion from the blood sugar spikes and crashes.