Does insurance cover Ozempic? Often, Ozempic is not covered by insurance when prescribed specifically for weight loss alone. However, it may be covered as a treatment for type 2 diabetes and, in some cases, for pre-diabetes.
Ozempic was approved in 2017 for treatment of type 2 diabetes, while a higher dose of semaglutide was approved in 2021 for weight loss under the name Wegovy.
Ozempic is covered by most Medicare and insurance plans (source: MMIT). If you have a Medicare Part D or Medicare Advantage plan, about 85% will cover this medication.
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.
It's also approved for use in people with a BMI of 27 or greater, who have an accompanying overweight- or obesity-related condition, such as high blood pressure or sleep apnea,” Dr. Dominguez says. Ozempic is sometimes prescribed off-label for weight loss but is mostly used to treat people with diabetes, she says.
Ozempic prescription information
Ozempic® (semaglutide) is a medication approved by the FDA for the treatment of type 2 diabetes. It has also been shown to produce a significant weight loss effect and is prescribed by FORM doctors when appropriate.
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. Ozempic is No. 10 for the highest total Medicare Part D spending in 2021, according to data from the Centers for Medicare & Medicaid Services (CMS).
Ozempic is a highly sought after drug for managing diabetes and weight management, but it is important to know that it is prescription only. In Australia, this means you will need to speak with your doctor and have a prescription written up before you can start taking Ozempic.
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).
On the PBS, Ozempic costs Australians about $42 a month (four weekly injections). On a private prescription, the cost is about $132 a month.
How Long Can You Stay on Ozempic (semaglutide)? 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 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.
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).
To get approved for a Semaglutide prescription, you have to go through your primary care physician or another approved medical professional. They will give you a full medical assessment and overview to ensure it's the right option for you.
Following the DA communication, health professionals have now been asked to prescribe and dispense Ozempic for only those adults living with type 2 diabetes.
Saxenda is an approved weight loss medication, and is readily available in Australia. Cost is approximately $387 a month. The knock on effect from the Ozempic shortage, is that Trulicity which is manufactured by Ely-Lilly is now in short supply.
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.
People with private insurance will ultimately get Ozempic at a cheaper price. This could be as low as $25 for a month for a 1-, 2-, or 3-month supply, Oronsaye said. If paying out of pocket, you might be able to get it cheaper if your pharmacy takes discount cards, such as GoodRx.
How much is a monthly supply of Ozempic? The average monthly cost of Ozempic is $209. What is the cost of Ozempic without insurance? Ozempic can be expensive without insurance.
Ozempic is approved for people with Type 2 diabetes. And Wegovy is approved for people with obesity or those who are overweight and have health problems related to excess weight. If you lose weight with new drugs, you likely will need to keep taking the medications forever to keep the weight off.
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 does Ozempic work? The active ingredient in Ozempic is semaglutide, which works by inducing satiety. This feeling of being satisfied or “full”, suppresses appetite. This is why it works for weight loss.